Harrow Local Safeguarding Adults Board (LSAB)

Transcription

1 1 Harrow Local Safeguarding Adults Board (LSAB) Safeguarding Adults Annual Report 2011/2012

2 2 Index Page Foreword 3 Section 1 - Introduction to the Annual Report The Harrow Local Safeguarding Adults Board (LSAB) LSAB accountability 6 Section 2 National and local context Outcomes for and experiences of people who use services Leadership, Strategy and Commissioning Service delivery and effective practice Performance and Resource Management Working together 22 Section 3 - Statements from key LSAB partners 24 Section 4 - Delivering outcomes progress on year 2 of the Business Plan 41 Section 5 Objectives for 2012/13 year 3 of the Business Plan 52 Section 6 Appendices 62 Appendix /2012 Statistics Appendix 2 76 LSAB Prevention Strategy as at April 2012 Appendix 3 82 LSAB Quality Assurance Framework Appendix 4 83 Training statistics Appendix 5 86 LSAB Terms of reference and membership Section 7 Further information/contact details 92

3 3 Foreword This is the 5 th Annual Report published on behalf of Harrow s Local Safeguarding Adults Board (LSAB) and contains contributions from its member agencies. The Board coordinates local partnership arrangements to safeguard adults from harm. I am very pleased that over the last year a lot of progress has been made, for example: we continue to see a growing number of people contacting us with concerns, suggesting that our publicity campaigns and briefing sessions are having a positive effect; we have done some creative work in partnership with the Police to raise awareness with the Banks about financial abuse; we have independently audited our work to ensure we always aspire to achieve best practice; and we have been given for the first time a set of national safeguarding adults data so that Harrow can compare its progress against work underway in other places, which is always important and helpful. Many people will have been shocked at the abuse uncovered by the BBC Panorama programme at Winterbourne View near Bristol. It was very important that the Harrow LSAB considered the issues highlighted by the documentary so that any learning could be implemented locally. I am also very pleased that we were able to sustain robust safeguarding arrangements during periods of reorganisation and financial pressures in a number of our partner agencies. The key priorities for the LSAB in the coming year include: adopting a different approach to community engagement so that we are confident the safeguarding adults message is reaching everyone developing a special risk assessment tool that helps us assess whether residential and nursing homes are providing the best possible care working even more closely with Children s Services so that we share our relative knowledge as much as possible e.g. on safer recruitment practices and training finding more creative ways to obtain vulnerable adults views of local safeguarding services and using their feedback to make further improvements In conclusion, a lot of work was done last year with plenty of opportunities to learn from our own practice as well as that of other authorities. I remain committed through my chairing of the LSAB to ensure that its vision is realised - that Harrow is a place where adults at risk from harm are safe and empowered to make their own decisions and where safeguarding is everyone s business. Paul Najsarek LSAB Chair (Corporate Director of Community, Health and Wellbeing)

4 4 Harrow is a place where adults at risk from harm are safe and empowered to make their own decisions and where safeguarding is everyone s business (LSAB Vision) SECTION 1 - INTRODUCTION

5 5 1. Introduction to the annual report Safeguarding vulnerable adults is a responsibility placed on health and social care through the No Secrets guidance (Department of Health 2000) which is issued under Section 7 of the Local Authority and Social Services Act 1970 (see also Appendix 5). Through this mandatory guidance, statutory health and social care organisations have a duty of partnership to work together to put in place services which act to prevent abuse of vulnerable adults, provide assessment and investigation of abuse and ensure people are given an opportunity to access justice. The No Secrets guidance gives the Local Authority (Harrow Council) a leadership and co-ordinating role to ensure that all those who provide services for local people work together to address the safeguarding agenda in the borough. A vulnerable adult as defined in the No Secrets guidance is: a person aged 18 or over who is or may be in need of community care services by reason of mental or other disability, age or illness; and who is or may be unable to take care of him or herself or unable to protect him or herself against significant harm or exploitation Abuse is a violation of an individual s human or civil rights by any other person or persons (No Secrets 2000). Abuse can happen anywhere - in someone s own home, on a bus, in a care home, in community care or in a hospital. It may be behaviour that is intended, or caused by a lack of training and/or ignorance. Abusers (perpetrators) are often already known by the vulnerable adult. Abusers can be people such as a professional worker, another service user, a relative, a friend, a group or an organisation. This Annual Report describes all the activity carried out by the partnership organisations that form the Harrow Local Safeguarding Adults Board (LSAB) to support the safeguarding of vulnerable adults during 2011/12. The Terms of Reference for the Harrow Local Safeguarding Adults Board (LSAB) can be seen at Appendix 5 with the detailed statistics at Appendix 1.

6 6 1.1 The Harrow Local Safeguarding Adults Board (LSAB) The Local Safeguarding Adults Board (LSAB) has been chaired by the Council s Corporate Director of Adults and Housing (Community, Health and Wellbeing from 1 st February 2012) for the last 4 years. The LSAB is the body that oversees how organisations across Harrow work together to safeguard or protect vulnerable adults who may be at risk of harm, or who have been abused or harmed. The LSAB s membership includes the following agencies working in Harrow: the Metropolitan Police; Harrow Council; NHS Harrow; North West London Hospitals NHS Trust; Central & North West London NHS Foundation Trust; Royal National Orthopaedic Hospitals NHS Trust; Ealing and Harrow NHS Community Organisation; Harrow Mencap; Age UK Harrow; Harrow Association of Disability; Harrow MIND; Harrow Carers; LinkUp; Support For Living; the London Fire Brigade; Harrow LINk; Freemantle; Mears; Care UK; Gentle Care; Stanmore Residential Home; the London Ambulance Service, Trading Standards and the Care Quality Commission (CQC). A full list of current members is included with the Terms of Reference at Appendix 5. The LSAB takes its leadership role very seriously with appropriate senior management attendance from member organisations and (for the Council) the active involvement of the elected Councillor who is the Portfolio holder for adult social care, health and well-being. 1.2 LSAB Accountability The LSAB s Annual Report 2010/2011 was presented to the Council s Scrutiny Committee in September This report for 2011/2012 will go to a Scrutiny meeting on the 9 th July For the first time last year, the LSAB Annual Report was provided in both Executive Summary and accessible formats and was available to a wider audience through the Council and partner agencies websites.

7 7 Harrow is a place where adults at risk from harm are safe and empowered to make their own decisions and where safeguarding is everyone s business (LSAB Vision) SECTION 2 NATIONAL AND LOCAL CONTEXT

8 8 2. National and Local context There were a number of national developments in relation to safeguarding vulnerable adults in 2011/2012. i. Government Statement In May 2011 the Care Services Minister announced the Government s six guiding principles that must underpin local safeguarding arrangements: empowerment supporting people to make decisions and have a say in their care protection support and representation for those in greatest need prevention it is better to take action before harm occurs proportionality safeguarding must be built on proportionality and a consideration of people s human rights partnership local solutions through services working with their communities accountability safeguarding practice and arrangements should be accountable and transparent Both the government statement and the Law Commission s report on reforming social care law published on 11 th May 2011 recommended putting safeguarding boards on a statutory footing. Harrow LSAB response The Government s guiding principles have been adopted by the LSAB in its Business Plan. Membership of the LSAB is representative and at a senior enough level that key decisions can be taken forward. The LSAB has a prevention plan in place and has worked hard to ensure accountability of its work. More will be done in 2012/2013 on both user and community engagement. ii. Health and Social Care Bill The Bill that has been going through Parliament in recent months includes proposals to: increase GP powers to commission services on behalf of their patients strengthen the role of the Care Quality Commission (CQC)

9 9 Harrow LSAB response All GP surgeries in the borough have been offered awareness briefing sessions developed using the British Medical Association tool. A place has been allocated on the LSAB for a GP representing the Clinical Commissioning Board group (CCBG). CQC has an allocated place on the LSAB and attend at least once each year. There is a good day to day working relationship between the Safeguarding Adults Team and local CQC inspectors. iii. Safeguarding in health services During 2011, NHS London rolled out the Safeguarding Adults Assurance Systems through the commissioning clusters safeguarding leads. The assurance framework focuses on the following standards relating to commissioning and safeguarding: there is a commissioning strategy for safeguarding adults systems are in place to set safeguarding adults into all contracting and procurement processes commissioners report on safeguarding adults as part of assurance and accountability commissioners have robust assurance for safeguarding adults standards and processes to escalate risk workforce development includes safeguarding adults commissioners can demonstrate how they discharge their roles and responsibilities as a supervisory body - as required by the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS) Harrow LSAB response The NHS Self Assessment Framework (SAFF) was discussed at two LSAB meetings in 2011/2012 and has been a useful tool in identifying local priorities for improvement. The priorities are included in some of the NHS organisations submissions at section 3 of this report.

10 10 iv. Self neglect and adult safeguarding The Social Care Institute for Excellence (SCIE) has published a report about the relationship between adult safeguarding and self neglect. This was developed in the context that No Secrets and the pan London Policy/procedures focus on harm that is done to a vulnerable adult by others and not by the person to themselves. Harrow LSAB response During the last year the LSAB has overseen the development of a protocol to work with harder to engage individuals, including chronic hoarders. This will be piloted in 2012/2013 with outcomes reported back to the LSAB As part of its work programme in 2011/2012 the LSAB discussed/agreed actions relating to all the national developments which are incorporated in the update of the Business Plan and the objectives for 2012/2013. The remainder of section 2 has been structured under the 5 thematic areas suggested in the Association of Directors of Adult Social Services (ADASS) standards for safeguarding adults 2011: outcomes for and the experiences of people who use services; leadership, strategy and commissioning; service delivery and effective practice; performance and resource management; and working together. However it only provides information on those areas not addressed in section 4 where progress on the objectives in year 2 of the Business Plan is covered in detail. 2.1 Outcomes for and the experiences of people who use services i. Domestic Violence Forum/MAPPA/MARAC/Prevent Panel/Hate Crime Forum The Safeguarding Adults Coordinator is a member of these 4 key partnership groups with a view to raising the profile of disabled/older/mentally ill adults within the wider community safety agenda. Outcomes There have been a minimum of 20 referrals into and out from these forums ensuring that there is clear inter-agency communication about the most high profile/at risk individuals or families in the borough.

11 11 ii. Independent Mental Capacity Advocate (IMCA) statistics Independent Mental Capacity Advocates have a specific role that was introduced in the Mental Capacity Act 2005 (MCA). This Act gave some people who have been assessed to lack capacity the right to be supported by an IMCA if certain decisions are being made about their care. The MCA places a statutory duty on authorities to involve an IMCA when a person has been assessed to lack the capacity to make decisions about: serious medical treatment and change of accommodation. In the context of this report, IMCAs can also be instructed under discretionary powers if a decision is being made about the safeguarding of a vulnerable adult or if a care review is being held. In safeguarding cases an IMCA may be instructed even if family and friends are being consulted. A new provider was selected for 2011/2012 following a tender process led by Westminster Council on behalf of the West London consortium. The service in Harrow is now provided by POhWER, an organisation that is independent of the Council and the NHS. The IMCA statistics are monitored quarterly to ensure that the service is being used appropriately. In 2011/2012 all borough's showed a dip in the use of IMCAs in the first quarter which is best explained by a lack of awareness of the changes in procedures following handover from the previous provider to the new one. Outcomes Harrow has shown a steady increase in the use of IMCAs in the last year and during the final quarter their use matched projected levels for the first time. At thirteen referrals per 100,000 population Harrow sits in the mid range compared with other Boroughs, but is one of the higher users of IMCA services against comparator outer London boroughs. However the use of IMCAs in safeguarding cases has been low during the year and will need to be closely monitored in 2012/2013. iii. Working with service users There have been regular items about safeguarding in News and Views the publication for service users produced by the Council s User Involvement Team. There have also been updates on safeguarding work at each of the Partnership Boards in the borough all of which have service users represented at them. One of the users employed by the User Involvement Team has been involved in local hate crime work.

12 12 There has been ongoing work on the dignity challenges at user committees in each of the Neighbourhood Resource Centres. A service user was a panel member when the Safeguarding Adults Practice Adviser was recruited in the summer last year. Outcomes The appointment of the newly recruited permanent Safeguarding Adults Practice Adviser was fully endorsed by the user who was involved in her interview process. A new set of fully accessible information about safeguarding adults services has been drafted and will be in use in 2012/ Leadership, Strategy and Commissioning i. LSAB Business Plan/vision and principles The Harrow LSAB developed its first Business Plan in 2010/2011 and progress on the Year 2 (2011/2012) objectives is covered in section 4 of this report. Throughout the year the LSAB has continued to benchmark its work against relevant best practice documents including: the Association of Directors of Adult Social Services (ADASS) standards for adult safeguarding 2011; Learning from Serious Case Reviews (London JIP 2011) and the first set of national AVA (abuse of vulnerable adults) statistics. The Business Plan includes (as appendices) separate strategies for training and development; prevention and dignity in care progress against all of which has been reviewed by the LSAB in 2011/2012. ii. A strategic approach to adult safeguarding In 2011/2012 the Board worked on the actions in Year 2 of its Business Plan. At its business meetings and Annual Review Day during the year, the following topics under each of the sub-group areas were addressed:

13 13 Harrow LSAB business meetings work areas covered in 2011/2012 Prevention and Community Engagement Community Safety - in the context of the Pilkington case Progress on the Prevention Strategy (including the dignity agenda) Arrangements for World Elder Abuse Awareness Day 2011 in Harrow The Winterbourne View documentary and any implications for Harrow Community engagement options Training and Workforce Development Formal review of the multi-agency training programme Local implementation of the Mental Capacity Act evaluation of practice Quality and Performance Review Quality assurance framework for safeguarding adults work Impact of budget allocations on safeguarding adults work Dignity Audit findings Benchmarking performance against the ADASS standards File audit findings Quarterly statistics Report into an independent case review New procedure for dealing with complaints about the safeguarding adults process

14 14 Policies and Procedures/Governance Implementation of Protecting Adults at Risk London multiagency policy and procedures to safeguard adults from abuse The LSAB Annual Report 2010/2011 New Information Sharing Protocol Risk assessment Safeguarding Adults and Clinical Governance in the NHS NHS Self Assessment Framework (SAF) for safeguarding adults work iii. Elected member briefing sessions One session for 17 elected Councillors took place in 2011/2012. There was also a comprehensive discussion about the LSAB Annual Report with Scrutiny members on 14 th September Outcomes Elected members expressed a wish to review Harrow s performance against other similar boroughs. It has been possible this year for the first time (using the national AVA statistics) to do that analysis which will be reported to the Scrutiny Committee in July Further details are given at section 2.4 (iv) below. iv. Links with other strategies There is clear reference to the vision and principles of the LSAB in the Harrow Joint Strategic Needs Assessment (JSNA). This has been the case for the last few years, however there has been an opportunity to update this in recent months. There is also a new reference to safeguarding adults work in the Harrow Community Safety plan with particular reference to hate crime, distraction burglary and trading standards issues. There is a reference to safeguarding adults work in the Harrow Domestic Violence strategy.

15 The Safeguarding Adults Coordinator is a member of relevant strategic forums where there is ongoing multi-agency partnership working i.e. Multi-Agency Public Protection Arrangements (MAPPA), Anti-Social Behaviour Action Group (ASBAG), Multi-Agency Risk Assessment Conference (MARAC), the Prevent Panel, Domestic Violence Forum and the Hate Crime Forum. Outcomes As stated above, there have been a minimum of 20 referrals into and out from these forums ensuring that there is clear inter-agency communication about the most high profile/at risk individuals or families in the borough Service delivery and effective practice i. Working with harder to engage people See section 2.0 (iv) above. ii. Pathways guidance In order to provide absolute clarity about which organisation leads investigations under a specific set of circumstances, multi-agency pathways guidance was developed. This has been in use since December 2011 and will be formally reviewed in December Outcomes There have been improved processes in allegations about abuse in continuing care cases and those where District Nurses are the main workers involved, leading to speedier interventions to protect vulnerable people. iii. Information Sharing Protocol No Secrets [DH 2000] states that the government expects organisations to share information about individuals who may be at risk from abuse. It is important to identify an abusive situation as early as possible so that the individual can be protected. Withholding information may lead to abuse not being dealt with in a timely manner. Confidentiality must never be confused with secrecy.

16 16 Investigating and responding to suspected abuse or neglect requires close co-operation between a range of disciplines and organisations. Safeguarding adults work is concerned with sharing personal information, both about someone who is alleged to have experienced abuse and an alleged perpetrator. In November 2010 an updated cross agency information sharing protocol was agreed with the aim of further clarifying the safe and secure framework for sharing information among partner organisations in Harrow. This protocol was the version used in 2011/2012. Outcomes There have been a few cases in 2011/2012 where use of the new information sharing protocol has enabled (in particular) NHS professionals to share relevant information at case conferences. iv. Local Best Practice Forums There were 4 multi-agency Best Practice Forums organised and run by the Safeguarding Adults Team in 2011/2012. They were well attended from across all partner agencies (233 staff in total) and covered the following topics: Mental Capacity Act/DOLS; learning from case file audits; sharing best practice; risk/duty of care and specific case discussions. Positive outcomes include: production of additional A4 Guidance Notes responding to frequently asked questions at the sessions; changes to the training programme to include new topics including my role as a SAM and nothing about me without me new advice sessions provided by the Mental Health lead professional to support the District Nurses in their day to day work with patients who may not have capacity 2.4 Performance and resource management i. Quality assurance framework In 2011/2012 the well established quality assurance approach (see Appendix 3) continued which (for the Council) relates to an overarching QA framework, ensuring effective oversight and governance. User/carer challenge is at the centre of the approach and there are 4 other sections independent challenge ; provider challenge ; professional challenge and continuous learning. The following are examples of the activities that were undertaken with the resulting outcomes:

17 17 internal file audit by the Safeguarding Vulnerable Adults Team (SGVAT) external (independent) file audits 30 cases the second round of external audits started a new process of interviewing clients who have been safeguarded to see if their desired outcomes were met live audit of cases by Safeguarding Adults Practice Advisers the Safeguarding Adults Team had oversight of most cases dealt with during the year and provided (minimum) monthly feedback on practice to managers relevant performance indicators (e.g. numbers of repeat referrals) continue to be closely monitored as a way of judging the effectiveness of practice ongoing surveys of service users by Age UK Harrow in 2011/2012 included questions about feeling safe and dignity the Department of Health user survey included questions about feeling safe further work on dignity was carried out e.g. an event for Dignity Action Day hosted by Harrow Churches and Creative Support in March 2012 at Ewart House and a workshop for local domiciliary care providers on the report by the Equality & Human Rights Commission what rights older people get when they get care at home 4 multi-agency Best Practice Forums were held see section 2.3 (iv) above presentations were made to the LSAB on the outcomes from case inquiries and any learning that had been taken from them the LSAB received reports on the file audits carried out so that it could reassure itself as to the quality of casework in the borough Outcomes As a direct result of the above there have been a number of positive outcomes: development of a multi-agency pathways tool to ensure clarity about who leads in each case scenario additional training and briefing sessions given on the Mental Capacity Act (MCA)/Deprivation of Liberty Safeguards (DOLS) - in response to file audit findings and implementation of the actions arising from a specific audit of MCA/DOLS implementation introduction of a new on-line e-learning training module

18 18 changes made to the way that service users were followed up at the end of the safeguarding process. This will now be no later than 4 weeks after case closure so that user recall of events is clearer and there is no need to revisit painful memories several weeks/months later ii. Performance Indicators There were a range of performance indicators monitored in 2011/2012 as follows: % of protection plans accepted by the client (excluding those without capacity to consent) = 83.55% - this indicator remained relatively stable throughout the year. The percentage that didn t accept their protection plans equates to 38 clients. % of completed referrals with substantiated abuse which led to criminal prosecution/formal caution = 7% - this has increased by 1% since the last figures were produced. Ratio of % of referrals from Personal Budget (PB)/Direct Payment (DP) cash clients to PB Harrow held clients = 1 - this has increased from 0.67 to 1. A score of 1 indicates that a service user is no more likely to have been subject to safeguarding adults processes if they receive cash to purchase a service (PB/DP) or have the Council manage the service (PB Harrow held). Ratio of % of referrals with financial abuse from PB/DP cash clients to PB Harrow held clients = this has increased from 0.32 to 0.9. Previously a service user was significantly more likely to have a safeguarding adults issue with financial abuse if they had a Council managed service as opposed to receiving cash to manage their own service. There is now only a slight bias of Council managed services over PB/DP cash clients with regards to financial abuse. As more people take cash budgets this position is the expected trend. iii. Independent Case Reviews At its meeting in February 2011, the Harrow LSAB agreed to undertake an independent review of the case of Mrs R. Lowe Consultancy carried out the work and a report was presented to the LSAB in March 2012 with a set of recommendations which were agreed for implementation in 2012/2013. Further information including outcomes from this work is detailed under Theme 3 in section 4 of this report. iv Management information (statistics) The Board collates multi agency information on a range of adult safeguarding statistics in order to produce a management report. The report which is available quarterly is overseen by and discussed at the LSAB.

19 It attempts to identify trends in referral data and to provide accessible and useful statistics to Board members which can then be used to inform decisions e.g. identifying where awareness campaigns or training should be focussed. Headline messages For the first time it has been possible to compare the Harrow data against the national annual Abuse of Vulnerable Adults (AVA) data. This section therefore provides both a comparison with 2010/2011 Harrow performance and the national figures alerts compared to 400 in 2010/11 - a growth in number is positive, however it will be important to ensure that only appropriate alerts are recorded 64% of alerts were taken forward as referrals (352 referrals), compared to 48% in 2010/2011. The AVA figure is 57% which suggests that in Harrow primarily relevant cases are taken forward from alert to referral stage repeat referrals increased from 3% in 2010/11 to 6% in 2011/2012. The AVA figure is 14%. It is possible that Harrow s previous figure was slightly low as some repeat referrals are to be expected. Too high a figure suggests that work is not being done correctly or thoroughly first time around so this is an important indicator to monitor closely completed referrals increased from 59% in 2010/2011 to 90% in 2011/2012 which is excellent progress suggesting that the majority of cases are progressing to a conclusion and are not drifting. This is also very good performance in comparison to the national figure of 78 40% of referrals were from different ethnic backgrounds compared to 36% in 2010/2011 (a rise of 100 referrals) a positive change given that this was an LSAB priority last year. It is not relevant to compare the Harrow figure with the AVA statistics as the national population profile is very different to that of London statistics showing where the abuse took place remain broadly similar to 2010/2011with the highest percentage in the client s own home (50%) and 24% in care homes (long term and temporary placements). The AVA figures are 41% and 34% respectively which are broadly in line with the Harrow position the highest proportion of allegations remain for older people at 51% (179 people), compared to 61% nationally (also the highest percentage compared to other care groups) the figure for people with a learning disability was 22% (79 people), a slight reduction from 23% last year. Harrow figures have previously been high so it is reassuring that they have reduced and are now more in line with the national figure of 20%

20 figures for mental health show an increase from 10% in 20120/2011 to 14% (50 people) in 2011/2012 compared to the national figure of 23%. The numbers in Harrow have improved over the last 2 years, however there appears to be some more work to do to reassure the LSAB that awareness is reaching all vulnerable adults in this area 20 the percentage for physical disability was 6% in Harrow (21 people) showing a small reduction of 4% on last year s figures and lower than the national picture which is 18%. As for mental health this may suggest that further awareness raising is required in this area allegations of physical abuse remain the most common referral (28%) which is in line with the national figure of 30% neglect (18%), financial abuse (19%) and emotional abuse (23%) are the other significant figures with the statistics for all types of abuse being close to national figures (23%; 20% and 16% respectively) social care staff e.g. domiciliary care workers (22%) and family (25%) - are the most commonly alleged perpetrators and this is in line with the national figures of 25% for both. In Harrow this is the same picture as in 2010/2011 outcomes for victims are varied, however increased monitoring remains the most common at 15% compared to 26% nationally. An offer of assessment/community care services was slightly higher in Harrow (12%) than the national figure of 10% outcomes for the perpetrator included an increase in criminal prosecutions from 10 cases to 25 cases (7%) compared to the national figure of 5% (see also Section 4 - Theme 1 (vi) below) The full analysis of 2011/2012 statistical data is shown at Appendix 1. iii. LSAB Resources Apart from the time spent by all relevant managers and staff in local organisations, there are some financial/human resources specifically established for overseeing/coordinating the work of safeguarding vulnerable adults at risk in Harrow.

21 21 They are: The Safeguarding Adults Team one wte Safeguarding Adults Coordinator (Strategy) one wte Safeguarding Adults Coordinator (Practice) one wte Safeguarding Adults Practice Adviser one wte Manager Safeguarding Adults Services The Safeguarding Adults budget 2012/2013 (excluding accommodation costs etc.) Salaries (including all on costs) 198,686 Publicity/leaflets 2,550 Training 26,250 External/independent audit 8,630 Total 236,116 (Council funding 211,116 Income from statutory partners (excluding the Council) 25,000) iv. Reporting to the Scrutiny Committee There was comprehensive discussion about the LSAB Annual Report with Scrutiny members on 14 th September Outcomes Elected members expressed a wish to review Harrow s performance against other similar boroughs. It will be possible this year for the first time (using the AVA statistics) to do that analysis which will be reported to the Scrutiny Committee in July Further details are given at section 2.4 (iv) above.

22 Working together i. LSAB effectiveness The LSAB has a development item at each of its meetings to ensure that members keep up to date with best practice in safeguarding adults. There is more information about the topics covered in Theme 3 at section 4 of this report. The Board also has an Annual Review Day where it looks back at progress in the previous year and sets priorities for the coming year. ii. Working with Children s Services and the Local Safeguarding Children s Board (LSCB) There is a reciprocal arrangement in place between the Local Safeguarding Children s Board (LSCB) and the LSAB. The Senior Professional for Safeguarding Practice, Review and Scrutiny (Children s Services) attended the LSAB in 2011/2012 and the Safeguarding Adults Team Manager attended the LSCB. The reciprocal advertising of training opportunities (e.g. the safeguarding adults training programme references courses being commissioned by the LSCB) continued throughout the year. In September 2011, the LSAB ran a multi-agency best practice forum child protection for adult services workers which was attended by 61 staff (35 adult social care; 7 mental health; 3 NHS; 11 housing and 5 private sector) and covered the legislative framework and key responsibilities. During 2011/2012, a worker from the Safeguarding Adults Team joined the Multi-Agency Safeguarding Hub (MASH) as a link worker. All referrals into MASH are scrutinised by the adults link worker who provides advice about what impact a disability or mental health issue (where there is one) might have on the presenting parenting issues. It also ensures that any safeguarding adults concerns that might arise through this route are picked up. Outcomes There are excellent case examples that suggest improved outcomes for individuals as a result of the MASH collaboration. Reflective analysis by the Safeguarding Adults Practice Adviser about the situation for the vulnerable adult has led to a different approach being taken by Children s Services in some situations.

23 23 Harrow is a place where adults at risk from harm are safe and empowered to make their own decisions and where safeguarding is everyone s business (LSAB Vision) SECTION 3 STATEMENTS FROM KEY PARTNERS

24 24 3. Statements from key partners The following statements have been provided by some of the key agencies represented on the LSAB. The reports cover adult safeguarding issues from each organisation s perspective and some identify key priorities for 2012/ Royal National Orthopaedic Hospital NHS Trust The Royal National Orthopaedic Hospital, as a national hospital for orthopaedics, works across the UK and with local with partners in health and social care to safeguard adults at risk who access the Trust s services. The Matron for Adults and Clinical Nurse Specialist (CNS) for Safeguarding Adults are the nominated leads for the Trust and have worked together with the Harrow LSAB and NHS London in developing systems and policies to identify adults at risk accessing the Trusts services, refer and investigate concerns regards adults at risk. The Trust leads have been active members of the following work streams/objectives of the LSAB during 2011/12: Prevention and Community Engagement The Trust has worked in partnership with local stake holders to run staff awareness days on elder abuse and dementia with regular patient/staff awareness sessions by the local Alzheimer Society representative. The Trust has a Prevent Trainer and developed a formalised link with the Metropolitan Police regarding counter terrorism. Training and Workforce Development The Safeguarding Adults Awareness Training to all Trust staff both mandatory update and at induction has continued with higher compliance of staff attending from previous years. A Harrow Training Grid for the Trust was devised to identify appropriate Trust staff to attend relevant Harrow Safeguarding Adults Training Programme (Levels 1-3) which has increased the uptake of courses. The CNS for Safeguarding Adults gained a place on the Safeguarding Adults Leadership Programme funded by NHS London. Quality and Performance Review During the year the Trust continued to implement the adult at risk/vulnerable adult and dementia pathway to identify patients needing support throughout the patient journey and developed an adult at risk database to track patients to plan support during preadmission, admission and discharge. The Safeguarding Adults Committee has met monthly and expanded with a consultant psychiatrist and consultant ortho-geriatrician

25 joining during the year. The Care Quality Commission visited the Trust in June 2011 and were satisfied with its compliance with Outcome 7 (safeguarding people who use services from abuse) of the Essential Standards. Policies and Procedures/Governance During the year bi-monthly reports, policy review and presentations have been made to the Clinical Governance Committee and Trust Board. The Trust has linked safeguarding alerts/referrals electronically to its Incident Reporting System. Safeguarding Adults Self Assessment and Assurance Framework (SAAF) Actions for 2011/12 From the feedback, the thematic review of 2011/12 for the Trust was to further develop the work around the Trusts Strategy which will align with LSAB Strategy/ pan-london approach, Mental Capacity Act awareness/ training and commissioning reporting element of SAAF. Priorities for 2012/13 The Safeguarding Adults Committee has devised a Trust Safeguarding Adults Strategy linked to the LSAB Strategy and SAAF Targets with objectives/action plan to meet targets for the coming year the following focus: 25 conduct dementia audits develop dementia screening and clear patient pathway dementia and delirium training develop further links with North Central London NHS Clusters continue to work in partnership with HLSAPB work streams and awareness events externally and internally in the Trust increase Mental Capacity Act Awareness of all staff involved in patient care within the Trust 3.2 Ealing and Harrow NHS Community Organisation (ICO) Developments since April 1 st 2011 Following the creation of the Ealing Hospital Integrated Care Organisation on April 1 st 2011, a review of the Safeguarding Adults governance structures and board assurance framework across the Acute and Community Services commenced in August A Safeguarding Adults Summit was undertaken in August 2011 with key Safeguarding Adults Leads whereby a number of recommendations were made with regard to strengthening and developing a more integrated approach to managing, responding to and seeking assurances around Safeguarding Adults (SA).

26 A Safeguarding Adults Group (SAG) has been established to oversee the governance arrangements for the Trust, reporting into the Clinical Governance Committee. The SAG membership is drawn from senior leadership from within the respective Directorates of the ICO. The aim of this Group is to provide effective, consistent and seamless leadership around the Safeguarding Adults agenda for both community and inpatient services across the ICO. It will ensure there are Safeguarding Adults governance structures in place and provide assurance to the Board around the effectiveness of Safeguarding Adults Arrangements. The SAG will be chaired by the Executive Lead for Safeguarding and in his absence by the Deputy Director of Nursing. The Board reporting and leadership structure for Ealing Hospital Trust has been strengthened. The duties and responsibilities of the directorate leads have been more explicitly stated with the Executive Board Leadership provided by the Medical Director for Ealing Hospital Trust and the Strategic lead is the Deputy Director of Nursing The ICO has created an operational support function that will operate across the ICO and act as a key link between Social Services, the LSAB and Directorate leads providing support around core aspects of the Strategic Work plan. On April 1 st 2011 the ICO inherited a number of Policies and Procedures from the historical organisations (NHS Harrow/NHS Ealing/NHS Brent and Ealing Hospital Trust). As such there was a need to update these Policies with a view to creating an overarching Policy across the ICO reflecting core elements and principles of the Government Statement in May The Policy has now been revised and was available from January A Training sub Group has been established that reports into the ICO Safeguarding Adults Groups. This was established to agree the training standards and align the varying training programmes and competency frameworks across the four constituent parts of the ICO (Ealing Acute/Ealing Community/Brent Community and Harrow Community). In December 2011 a Quality and Safety walkabout was undertaken across the acute Wards to assess and evaluate knowledge, understanding and awareness of Safeguarding Adults procedures. The framework adopted to review the current position was drawn from the CQC outcomes. In addition, a quality outcomes framework is being developed for the Community Adult Nursing Services and Safeguarding Adults will be a key element of this review process. An ICO Wide Safeguarding Adults Register has been collated which holds the data and information of all SA cases and monitors and tracks progress along the seven steps of managing a SA case as set out in the Pan London procedures.

27 27 Areas to be strengthened in 2012/13 A key focus for 2012/13 will be to strengthen the strategic work plan focusing on the following key areas for action: continue to build on and enhance the partnership arrangements ensuring that strong relationships are built across the three Boroughs that the ICO interfaces with as part of the SA agenda a key focus for the organisation will be to ensure that it is well placed to respond to risk assessments undertaken by the Police and partner organisations around the potential rise in safeguarding cases during the period of the Olympic Games such as: increased use of alcohol and drug related issues exploitation of women increased number of adult with disabilities visiting London greater pressure on Accident and Emergencies increased risk of people with mental health problems and/or relapse increased risk of domestic violence and sexual assaults strengthen knowledge, awareness and understanding of adults at risk amongst staff ensuring they know how to raise an alert and refer to the appropriate agencies implement and embed standards set out in the Policy framework key polices for ratification in May 2012 are DOLS, MCA, Restraints and Domestic Violence to build on and enhance mechanisms for ensuring that patients/users and their families/carers are actively involved in the design, development and delivery of services ensure that there is evidence at various levels of patient/user involvement; specifically those more at risk groups and their families/carers are enabled to engage in service development e.g. groups for equality, dementia care systems to ensure person centred care is delivered and meets the needs of patients/users at particular risk of neglect harm or abuse strengthen the training programme across the ICO with a view to increasing attendance at training and also introducing e based training modules particularly for level 1 to better understand the clinical practice and health specific issues that emerge from safeguarding cases through enhanced collation, triangulation and use of information from investigations/strategy meetings and case conferences

28 28 to raise awareness and understanding of DOLS and Mental Capacity Act, demonstrating strong leadership across the organisation ensuring that consent and decision making is connected to best practice in safeguarding adults Ealing Hospital Trust to develop a robust annual audit programme to assure itself that safeguarding systems are in place effectively 3.3 NHS Harrow NHS Harrow is committed to working with its partners in health and social care to safeguard adults at risk. NHS Harrow s Deputy Borough Director (Javina Sehgal) is the nominated lead for safeguarding adults, representing NHS Harrow at the local Safeguarding Adults Board meetings. Progress on Priorities for During , NHS Harrow has taken the lead in investigating three adult safeguarding concerns (issues such as poor nursing care and poor record keeping) relating to service users whose care packages are funded by NHS Harrow. Two of the cases were substantiated and the findings and recommendations of each investigation were reported back to the Harrow Adult Safeguarding Team. NHS Harrow s progress towards ensuring full adherence with the Pan London Multi Agency Safeguarding Adults Procedures has been positive, with the completion of the Self Assessment and Assurance Framework (SAAF) in November 2011 highlighting good progress in terms of NHS Harrow s partnership and commissioning responsibilities. This has been supported by the commissioning of health services focusing on the key principles of: patient care achieving high quality care for patients protecting them from avoidable harm ensuring high degree of compliance with regulations as a fundamental requirement for commissioning services NHS Harrow has also ensured that all services commissioned are fully compliant with requirements such as the Human Rights Act, Equalities Act, Mental Capacity Act and Safeguarding Vulnerable Groups Act. Progress to date includes: all staff, both new and currently employed, attending introduction and advanced safeguarding adults training that is appropriate to their level of responsibility for patient care all provider contracts containing a safeguarding clause, supported by key performance indicators, as a core requirement

29 29 quality assurance and monitoring of providers with regard to performance against key indicators of patient care and safety all provider contracts containing a clause which makes mandatory the need for service provider organisations to produce their own guidelines, which are consistent with local safeguarding adults multi agency procedures Serious breaches and concerns are regularly reported to the Executive Management Team and NHS Harrow s Board for governance purposes. Priorities 2012/2013 The actions identified in the strategy and commissioning domains of the Self Assessment and Assurance Framework (SAAF) completed in November 2011 resulted in a number of recommendations made to NHS Harrow s Executive Management Team (EMT). The aim of these recommendations is to achieve improved performance resulting in greater quality assurance and compliance with the requirements of safeguarding adults. These recommendations include:- STRATEGY establish a Safeguarding Adults Executive as a subcommittee of the Harrow Clinical Commissioning Board (CCB) to provide the governance and accountability structure for the Harrow CCB and enable robust quality assurance of safeguarding adults policy, processes and procedures being delivered through commissioned services develop and implement an adult safeguarding strategic plan which integrates patient safety, clinical governance and quality assurance develop and implement an algorithm that provides an overview of responsibilities associated with key roles and clarifies the internal accountability and assurance framework identify a GP Commissioning lead to champion the interests of safeguarding adults within commissioning decisions, ensure safeguarding adults interests are considered in strategic decision making and represent the Harrow CCB at the Harrow Safeguarding Adults Board (together with the management lead for safeguarding adults) develop and implement a system whereby learning from strategic and operational safeguarding adults structures are shared across commissioned providers, where relevant and with the Harrow CCB

30 30 COMMISSIONING develop and implement consistent quality assurance mechanisms through which safeguarding is routinely monitored as part of all contractual performance frameworks implement annual audit of safeguarding quality assurance outcomes for all commissioned services appoint a nurse manager lead for safeguarding adults to support commissioners with quality assurance at an operational level by developing and implementing robust systems and procedures as well as highlighting good practice develop and implement a training package covering the overarching principles and legal framework for safeguarding adults which is relevant to the commissioning responsibilities of associated staff develop and implement a rolling training programme for staff regarding safeguarding adults with associated processes for monitoring attendance and highlighting the need for refresher training 3.4 Age UK Harrow Prevention and Community Engagement Age UK Harrow continues to be an active member of the LSAB meetings and takes a leading role in the community awareness stream. Working with partners, Age UK Harrow is involved in WEAAD and is a strong part of the organisational team that makes the Elder Abuse Awareness Day a success in the borough with creative and innovative ideas. Focusing on prevention, Age UK Harrow is actively engaged in creating awareness by increasing knowledge amongst older people, volunteers and staff and is a point of contact for older people. As a part of its community outreach service Age UK are working with the Safeguarding Team to reach sheltered housing and the community to provide literature and give talks on elder abuse and safeguarding. Training and Workforce Development Age UK Harrow will continue to use the Council s safeguarding training and ensure volunteers and staff are kept up to date. Safeguarding is a part of the induction for new staff and volunteers.

31 Implementing further internal and external training and regular meetings with staff and volunteers as to actions to be taken in safeguarding situations and in order to air concerns and views. Quality and Performance Review For each staff member to log elder abuse and safeguarding issues so that the organisation has statistics for the types of abuse occurring, age group and resulting outcomes/actions etc. To have access to the council s statistics on safeguarding so that as an organisation Age UK is more aware of particular areas of concern etc. Review of the safeguarding referral process to identify barriers and suitably address any issues. Policies and Procedures/Governance The staff and volunteers work within the framework of the whistle blowing policy and abuse of vulnerable adults policy Harrow Association of Disability (HAD) HAD has been a member of the LSAB for a number of years. A key area that HAD has been keen was on the LSAB agenda is around ensuring risk assessing for clients who receive a Direct Payment /Personal Budget. This is also now high on the Council s agenda. When individuals take on responsibility for arranging their own care, they are vulnerable in a number of ways. In order to minimise this, a risk assessment completed by the allocated Care Manager is essential in supporting a service user to be able to successfully manage their own care arrangements. An example of this and an area that has been particularly problematic recently is around some service users not accepting their responsibilities when becoming an employer and putting in place the legal requirements; such as giving their staff a Contract of Employment. A recent local case in Harrow highlighted this problem when an ex-service user was taken to court by their Personal Assistant as they had not been given a Contract. HAD provides a support and advisory service to all service users who take on a Direct Payment and work very closely with the Personalisation Teams at Harrow Council. In order to monitor and minimise these problems and identify areas where there are problems through a risk assessment, it is anticipated that this will assist in preventing potential problems for vulnerable adults who go onto the scheme. This year, a member of staff at HAD co-ordinated and ran some training for service users with a learning disability. This involved a number of professionals training individuals on how to recognise abuse and keeping safe. Partnership working included working with Harrow Fire Services, Harrow Police, the Road Safety

32 Department and Harrow Council. These sessions have proved very successful and it is anticipated that this training will be rolled out again in the future. HAD has been a lead partner in working with both the Safeguarding Co-ordinator and Age UK in recognising World Elder Abuse Awareness Day; which this year is going to be held on Friday 15 th June The three organisations will be setting up information points within Harrow to raise awareness of abuse and how to report it for local residents. HAD s CEO sits on the Harrow Hate Crime Forum and the Special Projects Manager works with this department in particularly focusing on raising the profile of Disability Hate Crime and the reporting of it. HAD values the fact that they are a member of the LSAB to be able to contribute and raise issues that affect the many service users who access our organisation s services, who may be at risk and require access and support from Harrow Council and their Safeguarding services Harrow Mencap In 2012/13 Harrow Mencap will continue to work with people with learning disabilities on the recognition and prevention of abuse. The BMER outreach worker will extend her networks in seldom heard communities, attending community meetings and engaging with them on safeguarding and explaining procedures to safeguard people who are at risk of abuse. The health advocacy project will also reach out to people by providing education in order to minimise the risk of abuse. Training and development All Mencap staff undertake basic abuse awareness training as part of their induction. In 2012/13 Mencap will ensure that all staff who have been in post longer than 2 years undertake refresher training. Managers will undertake safer recruitment training and Mencap will ensure that there is a suitability qualified person on each panel. Quality and Review In 2012/13 Mencap s organisational lead will review each safeguarding referral to ensure that all agreed actions to safeguard an individual have been actioned and that the risk of abuse has been minimised. Procedure and Policies In 2012/13 Mencap will review its policies and procedures and will ensure all staff have an understanding of the correct procedure.

33 Central and North West London NHS Trust Introduction Safeguarding adults work in the Trust has continued to expand. A number of cases have proved to be particularly complex and distressing for those involved. Awareness of the issues around adults at risk continues to rise across all service lines. Safeguarding Adult Guidance A revised adult safeguarding guidance document has been produced in draft and disseminated to the Trust Adult Safeguarding Steering Group. This draft was achieved through close collaboration with Service Line Leads and Local Authority partners to ensure an effective and consistent response to allegations of abuse. Its aim is to assist staff in identifying potential or actual abuse and a simplified flowchart with pathway and process information for each borough will be included. This is in line with recently produced Pan- London Procedures and Department of Health Clinical Governance guidance. A copy of this guidance document will be provided to the next Quarterly Quality Review committee. Safeguarding Audit There has been an external audit of adult safeguarding processes and practice from a small selected sample of cases from Harrow. The cases chosen represented all the service lines within the borough. The auditors looked at referral decision making processes, what prompted the case to proceed to protection planning and the outcome. The auditors also looked at the level of training and support the care co-ordinator had received and if this was sufficient for the role. The preliminary findings are as follows: greater awareness needed of the Pan-London Procedures and Department of Health Clinical Governance guidance the need to make training available for staff employed before it became part of induction empowering front line staff to understand professional and employment obligations and the level of conduct required to safeguard patients within their care and making safeguarding everyone s business. This also includes clarity on pathways and processes in each borough increasing staff knowledge and awareness regarding the recognition of adult safeguarding integration of safeguarding into current reporting systems to fully implement clinical governance structures

34 34 Safeguarding Adults - The Process and Pathway The Trust Safeguarding Leads are setting up meetings between each local authority and the service lines that serve that borough. The aim of these meetings is to ensure that each service line understands its roles and responsibilities in that borough and for each service line lead to meet the borough local authority lead. We have completed meetings for Harrow. The expectation on the Trust from local authority partners varies depending on the structure the local authority employs and whether or not the Trust has a Section 75 partnership agreement with that borough. Domestic Violence There has been considerable emphasis over recent years on the role that NHS organisations can play in responding to and preventing domestic violence. There are named domestic violence leads in each borough who attend the monthly MARAC (Multi Agency Assessment Conference) to ensure that those at significant risk are offered a multi-agency response. Both Children and Adult Safeguarding Trust Leads have developed an e-learning package that will be made mandatory for all clinical staff with a view to improving the quality of referrals and ensuring greater protection of adults and children at risk. Proposed Developments Given the feedback from the audit and the fact that adult safeguarding has become more to the centre of activity within the Trust, it is proposed to carry out extensive publicity and awareness training within the Trust over the next 12 months. This will involve significantly increasing the profile around adult safeguarding in the light of the development of the new Trust guidance document. It is planned to have a workshop for Trust staff in October 2012 where the Trust guidance will be launched alongside a presentation on the Pan- London Procedures and Department of Health Clinical Governance guidance. The Hillingdon Local Authority lead was part of the group who led on the Pan London Procedures and has agreed to present at the workshop. There also needs to be some discussion about the need to involve users and carers where appropriate and this will be part of the development of a user and carer engagement strategy. The Quarterly Safeguarding Group will be receiving a report following the completion of visits to all the Local Authorities partners with recommendations that will include the role of clinical accountability and thresholds for safeguarding adult referrals and assessments.

35 Mind in Harrow Mind in Harrow is firmly committed to safeguarding adults in partnership with Harrow Council, the NHS, Police and independent sector organisations with a particular focus on adults at risk and potentially at risk owing to their mental health. In the past year , the following actions were completed: Membership the Mind in Harrow Chief Executive, Mark Gillham, is a member of the Harrow Multi-Agency Safeguarding Adults Board, which meets quarterly and has also contributed to the Prevention and Community Involvement Workstream strand Staff training - Mind in Harrow introduced a policy two years ago that all new staff are required to undertake the Harrow Council 1 day introduction to safeguarding training course. Additionally in , senior staff attended the new programme training day on risk assessment and conducting investigations aimed at managers Volunteer training - in this past year, Mind in Harrow extended safeguarding training delivered by Harrow Safeguarding to make it available to all volunteers who may come into contact with adults experiencing mental health needs Mental Health Service User Reps training training on safeguarding issues has been embedded for all new trainees of the Harrow User Group on a regular annual cycle Provide information - Mind in Harrow has offered support and information, as appropriate for a voluntary sector partner in conjunction with the Safeguarding Team, for those people with mental health needs who report that they may be at risk of abuse or mistreatment Policy review during , Mind in Harrow has revised its Safeguarding Adults Policy to include the 10 Dignity Challenges and updated the Equality & Diversity Policy to reflect the changes introduced by the Equality Act The Serious Incident Reporting Policy & Procedure was updated to reflect current good practice and a new Child Protection Policy was written and adopted. 3.9 Local Safeguarding Children s Board (LSCB) Prevention and Community Engagement a two year project to develop the engagement of the faith, BME community and voluntary sector groups considering a part time community development worker, with links to the LSAB, to embed the message that safeguarding is everyone s business

36 a project to encourage children and young people s participation in the LSCB and their feedback to the services and groups they use for improvement. This project will seek to especially engage marginalised groups, who face particular deprivation with the aim of improving wellbeing and meeting need to develop a safeguarding profile in Harrow at local events to impart safeguarding messages to young people, children and families Training and Workforce Development a review of the LSCB multi agency training programme with links to the LSAB in a task and finish group, looking at cross-cutting issues such as the impact on parenting of dual diagnosis i.e. mental health and substance misuse issues encouragement of best practice in LSCB training, including issues of evaluation, diversity and recruitment of local trainers so that partner agencies have increased benefit from training together Quality and Performance Review a scrutiny of safeguarding from a balanced community perspective through the LSCB Quality Assurance sub group audit calendar and audit days; a monitoring of agencies actions following learning from local and national incidents, following self evaluations and user feedback to ensure improved practice; 36 to ensure safer recruitment practices across both statutory and voluntary sectors through training, information raising and audit processes Policies and Procedures/Governance stronger links between the LSCB and LSAB, including considering overlapping policies and processes the integration of lay members and voluntary and community groups into the governance of the LSCB to ensure effective links and sharing of information with the new Health and Wellbeing Board and existing structures in Harrow 3.10 North West London Hospitals NHS Trust Safeguarding Adults at Risk remains a high priority for the Trust. NWLHT strives to ensure that local processes meet best practice standards and that key lessons are learned from both national and local safeguarding activity. Work has been on-going over the last year to review and update safeguarding policies, procedures and training. The Trust is committed to continue its focus on safeguarding, caring for patients with dementia and learning disabilities, and relating with focused activity on privacy and

37 dignity. At operational level during 2011/ 12, work has focused on putting in place robust plans and procedures, and has prioritised safeguarding training. This work has been in preparation for the establishment of a more formal Trust Safeguarding Adults at Risk Board. At NWLHT the Executive responsibility is allocated to the Director of Nursing. The Deputy Director of Nursing is the operational lead responsible for ensuring the needs of vulnerable adult patients are at the forefront of local planning and service delivery. Prevention and Engagement The new Trust Safeguarding Adults Board will report to the Governance Compliance & Risk Committee which brings together senior clinical and managerial representatives, to ensure that the Trust is complying with and implementing all national and local policy relating to Safeguarding Adults at Risk. The Trust acknowledges partnership working as a priority in Safeguarding Adults at Risk and the Trust is represented at the Harrow Local Safeguarding Adults Board. The Trust participates in the LSAB s work planning days, and is represented on a number of LSAB subgroups including workforce development and audit. Progress has also been made in collaboration with Social Care. Quality and Performance Review The Trust Safeguarding Adults Policy has been reviewed to reflect the Pan London Procedures. The Trust internal auditor scrutinised the effectiveness of arrangements to Safeguard Adults at Risk in March The audit identified actions and a robust action plan has been put in place. Actions include the setting up of the revised Trust Safeguarding Adults at Risk Board, the review of the Trust Procedures, and data capture. These recommendations have been included in the work programme and will be monitored by the Safeguarding Adults at Risk Board and reported to the Governance, Compliance and Risk Committee. The Care Quality Commission were satisfied with the Trust's compliance with outcome 7 (safeguarding people use services from abuse) of the Essential Standards. 37 Achievements in 2011/2012 proactive engagement Social Care teams in Harrow the improvement in training numbers compared to previous years the increased number of safeguarding alerts and the early recognition of safeguarding concerns, including tissue damage and neglect the involvement of Trust staff in reviews of the care and Case Conferences the engagement of staff across the Trust in the safeguarding agenda increased dementia awareness links with PALS and complaints regarding safeguarding development of the staff information leaflet

38 38 Safeguarding adults Self-Assessment and Assurance Framework (SAAF) The Trust completed the SAAF and has incorporated actions into the annual work programme. Priorities for 2012/13 The Trust Safeguarding Adults Board has an annual work programme, and will focus on the following: launch the revised Safeguarding Adults Policy to develop and implement an improved reporting system for capturing information about referrals to social services, which are made directly by clinicians or ward / departmental managers to improve the quality of reporting of safeguarding issues, to ensure that all relevant information is captured continue to strengthen staff skills and knowledge in managing patients with dementia to support the achievement of staff having undertaken the appropriate level of training as specified in the Trust Training Needs Analysis to build on the work undertaken for people with a learning disability to improve the pathway for patients and their carers develop a process for the flagging of patients with a learning disability on attendance at the Trust to develop a Supervision Strategy for the Safeguarding Adults at Risk in the Trust audit and peer review Safeguarding Adults at Risk activity development of a Trust Safeguarding Adults at Risk Strategy on-going implementation and monitoring of action plans following the SCRs, IMRs and Case Conferences on-going raising awareness of roles and responsibilities of staff within the Trust towards the Safeguarding Adults at Risk Safeguarding awareness day to promote Safeguarding Adults at Risk policies and procedures introduce a bi-monthly Safeguarding Adults at Risk Newsletter publish the Safeguarding Adults at Risk information booklet to complement the information leaflet continue to raise awareness of domestic violence in line with Harrow Local Safeguarding Children s Board. Prevent The key challenge for Trust staff is to ensure that where there are signs that someone has been or is being drawn into terrorism; staff can interpret those signs correctly, are aware of the support that is available and are confident in referring the person for

39 further support. The Matron for Older People and Safeguarding Adults at Risk is the Trust's Prevent Lead. The Department of Health in conjunction with the Home Office has developed training to raise awareness of Prevent. Training is of particular relevance to A&E staff, and Matron Davies has arranged for specific A&E training as required by the Department of Health Adult Services, Harrow Council Harrow Council s Safeguarding Adults Team takes the lead coordinating role for safeguarding vulnerable adults at risk from harm. This role is both in relation to multi-agency strategic development of the work as well as investigations into some complex individual cases of abuse and instances of institutional abuse. The Team also supports the LSAB arrangements; organises a range of public awareness campaigns; oversees the multi-agency training programme and runs briefing sessions. In 2011/2012 the Safeguarding Adults Team had a work programme which supported the overall objectives and priorities in the LSAB Business Plan and progress is monitored at the monthly Team Meeting. The work of the Team and the outcomes from its work programme are covered in the body of this report.

40 40 Harrow is a place where adults at risk from harm are safe and empowered to make their own decisions and where safeguarding is everyone s business (LSAB Vision) SECTION 4 PROGRESS ON OBJECTIVES 2011/2012 (YEAR TWO OF THE BUSINESS PLAN)

41 41 4. Progress on objectives for 2011/12 year two of the Business Plan The following areas were the priorities from Year 2 of the LSAB Business Plan and progress on each of the actions (as at 31 st March 2012) is set out below. Theme 1 Prevention and Community Engagement i. Implement year 2 of the safeguarding adults at risk prevention strategy Full details of progress against all the objectives are shown at Appendix 2. Headline messages/outcomes There are 30 objectives in the Plan and of these 15 were completed with 15 expected to be ongoing. Of the 30 objectives there are only 3 that need specific attention in 2012/2013 community outreach, further work on user involvement (both are LSAB priority areas), and implementation of the Sussex risk assessment tool for use in care/nursing homes. ii. Actively use the media for publicity campaigns There were a range of media items last year including: local radio coverage of the Hate Crime campaign launch; a local radio interview with Councillor Margaret Davine in relation to World Elder Abuse Awareness day and what Harrow was doing to protect vulnerable people (June 2011); articles in (i) the local paper (linked to Older People s Day in October 2011), (ii) News and Views for users with a learning disability (in April/May 2011), (iii) the local paper linked to Older People s Day, (iv) the Fire Safety magazine, and (v) the Council Tax booklet 2011/2012 which was delivered to every household in the borough. Outcomes: The Safeguarding Adults Team continues to receive alerts from members of the public following media campaigns suggesting that the message is being heard. However initial increases in alerts drop off a few weeks after each campaign, suggesting that messages need to be reinforced on a regular basis. There is no clear front runner in terms of the publication that is most successful, so it seems that a range of approaches is probably the most pragmatic way to continue.

42 42 iii. Run high profile campaigns e.g. WEAAD incorporating the zero tolerance message Campaigns in 2011/2012 included: a partnership event in the town centre for World Elder Abuse Awareness Day (June 2011); Carer s week (June 2011); Older People s Day (October 2011); Hate Crime campaign launch; Dignity Action Day (February 2012); 4 outreach sessions in the town centre cube with Age UK, HAD and the Police; and the MIND Hidden Minds long stay hospital user experiences campaign. Outcomes: Discussions at outreach sessions in the Town Centre with the Police led to some specific and positive work with the Banks on financial abuse. iv. Adopt a different approach to community engagement so that safeguarding adults at risk referrals are more broadly representative of Harrow s demographic profile Outreach into the community included stalls at the Under One Sky event; distribution of information to the 3 rd party reporting sites and 4 events in the town centre in partnership with the Police and voluntary sector. Outcomes: Statistics show an improvement in the ratio of alerts from BME communities suggesting that some of the outreach activity has been productive. The LSAB has agreed that further work needs to be done in 2012/2013. v. Improve community safety and address hate crime in relation to vulnerable adults at risk A Trading Standards representative joined the LSAB last year which will assist in raising the profile of this important area of work and is a reflection of the positive joint work already underway. There are strong links between the Safeguarding Adults Team and Community Safety workers and forums. Outcomes: The Safeguarding Adults Team joined in the Stop Hate UK campaign launch in March 2012 (in partnership with the Community Development Team, Police and Victims Support) to ensure that the disability aspects of hate crime were firmly on the agenda. This included signing up to the 24 hour helpline number.

43 43 vi. Improve access to the criminal justice system for victims The Safeguarding Adults Team continues to support both staff and users in contacting the Police when a crime is alleged to have been committed against a vulnerable adult. This has included supporting victims at Achieving Best Evidence interviews. Outcomes: There was an increase in criminal prosecutions from 10 cases in 2010/11 to 25 cases last year (7%) compared to the national figure of 5%. This demonstrates some steady progress in a difficult area. vii. Ensure risk assessments are completed and suitable information is available for self funders and people with personal budgets A risk assessment pilot was completed. The report to the LSAB on its findings was deferred due to pressure of business items. However the learning from the pilot will assist with amendments to the process in 2012/2013. File audits in 2011/2012 focused on how well risk assessments had been addressed. Outcomes: Amendments to the risk assessment process continue to be progressed. The findings of file audits were taken into best practice forums where advice on improving the assessment of risk was given. viii. Engage with Banks and utility companies to raise awareness of safeguarding and develop greater understanding of their role in both prevention and involvement in safeguarding cases Two further briefing sessions were provided for local Banks NatWest and Barclays which were well received. Outcomes: Discussions with the Police about financial abuse have led to a joint piece of work with all Harrow banks launched at Hendon Police College on 24 th February Agreement was reached about bidding for funds to run an information event for older and vulnerable people to coincide with Older People s Day 2012 in October. One Bank Manager contacted the Safeguarding Adults Team after attending a briefing session, to raise an alert about a person with a mental health problem experiencing pressure to spend her money ( 80k).

44 44 Theme 2 Training and workforce development i. Review the effectiveness of the new training programme and explore a wider range of delivery options e.g. e-learning or training the trainers Multi-agency training remains a high priority for the LSAB. The existing programme is competency based. This ensures that all staff know about the competencies required to meet their safeguarding adults responsibilities within the workplace. It helps staff and their managers to be clear about the safeguarding adults knowledge they require in their role, the training they should access and assists in the evaluation of training needs and professional development pathways. As a supplement to the formal training programme, the Safeguarding Adults Team also ran a number of briefing sessions across a range of agencies, offering most at the organisation s own premises. The new e-learning tool was launched at the end of January 2012 and feedback from early users has been positive. The multi-agency training programme was reviewed during the year and a revised programme will be run in 2012/2013 based on the findings of both the review and the training needs analysis. A full breakdown of the training statistics is shown at Appendix 4. Headline messages a total of 1,258 people received some training in 2011/ this was an increase of 187 people from 2010/ staff received formal training this was an increase of 111 people from 2010/2011 the breakdown of formal training was: 187 Council staff (an increase of 5 from 2010/2011); 131 NHS staff (an increase of 102 from 2010/2011); 3 Police officers (an increase of 2 from 2010/2011); 148 private sector staff (a decrease of 38 from 2010/2011) and 111 voluntary sector staff (an increase of 40 from 2010/2011) 678 people attended sessions run by the Safeguarding Adults Team (an increase of 76 from 2010/2011) the breakdown of briefing sessions was (summarised): 17 elected Councillors (an increase of 6 from 2010/2011); 27 Housing staff (an increase of 27 from 2010/2011); 46 NHS staff (an increase of 10 from 2010/2011); 254 Council staff (an increase of 154 from 2010/2011); 94 residential and domiciliary care staff - all sectors (an increase of 69 from 2010/2011); and 11 from voluntary sector

45 organisations (a small increase from 2010/2011). In addition there were briefing sessions for 138 service users (an increase of 41 from 2010/2011) and 15 carers (the same as in 2010/2011) there were some new organisations/individuals provided with training in 2010/11 as a way of extending safeguarding awareness: 12 staff from Harrow Helpline and the Emergency Duty Team Manager 45 some specific training on use of the Mental Capacity Act/Deprivation of Liberty Safeguards was also run on several occasions with a total of 172 staff from a range of organisations attending 34% of individuals (294 people) booked on to formal training courses cancelled, leading (as last year) to difficulties about the viability of some sessions Outcomes Formal review of the training programme and needs analysis has led to some new courses being included in the 2012/2013 programme e.g. nothing about me, without me. Following staff feedback many of the training and briefing sessions are now more experiential using current or recent (anonymised) case studies. External independent file audit is showing a marked improvement in understanding and use of the Mental Capacity Act, although there are still some staff where there is more training required. The wider range of people (albeit small numbers at this stage) contacting with alerts after a briefing session e.g. GPs and Bank staff, is very promising and suggests that awareness is increasing in new areas. The new e-learning course is allowing some front line staff to access training that they might otherwise not be able to e.g. GP trainees. Early feedback has been very positive that it provides an excellent alternative to classroom based sessions. ii. Mental Capacity Act and Deprivation of Liberty Safeguards (DOLS) audit implementation of findings In March 2011 the LSAB received a report on the independent audit of MCA/DOLS implementation in the borough. It was agreed that in 2011/2012 there would be two main focuses: changes to the training programme and briefing sessions so that the focus would be on more experiential learning through case studies and live case examples as requested by all the staff involved in the audit

46 46 monitoring of the changes made to FWi which were done to ensure the process starts with a focus on mental capacity As stated above, a total of 172 staff from a range of organisations attended specific sessions on this topic. Case studies were used on each occasion and feedback was generally positive. Monthly Mental Capacity Act surgeries are now held at each of the Adult Social care and with the District Nurses. There has been an increased take up of expert advice in the last few months. Outcomes: Some improvements are being demonstrated in file audits i.e. better use of capacity assessments where appropriate, however use of the IMCA service in safeguarding cases is low and the Mrs R independent case review considered by the LSAB found weaknesses in this area (see Theme 3 section (i) below). iii. Ensure a wider group of key people are appropriately briefed in relation to their role e.g. Councillors, GP s, Non Executive Directors, LINk members A briefing session was run for Electoral Register staff before they carried out their house to house visits. A letter was sent to all GP practices in the borough offering briefing sessions (developed using the British Medical Association tool) and introducing the link to the on-line e-learning tool. By the end of the year one practice (Belmont Health Centre) had taken up the offer with 2 other sessions booked at the Ridgeway Surgery and Pinn Medical Centre. Outcomes: One GP from the Belmont Health Centre has called the Safeguarding Adults Team for advice about a case and another has made a formal referral. The GP surgery involved in the learning from the Mrs R independent case review confirmed that they had discussed safeguarding adults practice at one of their clinical staff meetings and had amended their procedures. Theme 3 Quality and performance review i. Oversee the independent case review and report findings to the LSAB Lowe Consultancy completed the independent review into the Mrs R case as commissioned by the LSAB. Their report and recommendations were presented to the Board in March 2012 and an update on implementation will be given in September.

47 Outcomes: The LSAB was pleased to note that local services had not waited for the findings of the review before implementing improvements to local practice. Examples of progress include: 47 monthly Mental Capacity Act surgeries are now held at each of the Adult Social care and with the District Nurses. There has been an increased take up of expert advice since this case. There is a perceived improved ownership of capacity issues and an increased understanding of the difference between mental capacity and mental health a new protocol on working with hoarders/self neglect and hard to engage clients has been developed new pathways guidance has been completed which clarifies which agency leads in investigations the Safeguarding Adults Team now sends an to the relevant Service Manager of any cases they are concerned may be drifting the new Multi-Agency Training programme has more in-depth sessions for managers overseeing investigations all care workers at Healing Hands agency have received training in the Mental Capacity Act in CNWL the Legal team has developed a Trust wide document to cover capacity assessments. This is to be used for all formal assessments relating to capacity and is accessed by staff on the electronic system. Use of the form has been disseminated through the Trust Directorate and Sector meetings. All appropriate staff have received training on capacity and all new staff receive this on induction in the Council s Adult Social Care service, changes to the duty system in Personalisation Intake and Review resulted in more thorough screening of referrals and closer working between the duty system and the Team Managers. This gives managers better oversight of incoming work and a more robust process for identifying service users at risk An action plan was agreed by the LSAB which will be implemented in 2012/2013 and will take forward any outstanding recommendations from the review.

48 48 ii. Ensure that independent and internal audit programmes take place The Safeguarding Adults Team carried out file audits of 30 cases in 2011/12, including mental health and 5 live audits of active cases. There were two rounds of independent external audits of safeguarding cases in July/August 2011 and February/March The focus of all the audits was to pick up outcomes for clients, ensure that risk is being considered and build the findings into practitioner forum and training sessions. Outcomes/audit findings: The external auditor reported at the end of the year that the quality of decision-making and work is improved overall, especially up to and including the strategy meeting phase. Although some recording needs improvement, the underlying work is sound and all the vulnerable adults had been protected. Managers are being consistently more robust in closing inappropriate safeguarding adults processes at an early stage. There continues to be strong evidence of multi-disciplinary and multi-agency working and collaboration supporting positive outcomes for users. Previous concerns that Children s Services were not being consistently informed of concerns about children appear to have been addressed and there is evidence of appropriate referrals being made. The quality of thinking and recording of mental capacity issues is vastly improved, driven the auditor believes by the explicit sections of the referral form and the guidance therein. However there are some audited cases which indicate that further training in this area is needed for some staff. The auditor was pleased to record a commendable increase in service user, main carer and other significant family member involvement in strategy meetings and case conferences. Managers need to be more confident in concluding that a particular situation is in fact a complex care management case rather than a safeguarding one and record/action this robustly. Staff are still leaving too many blanks on the forms, often in key areas, including monitoring timescales, mental capacity, decision-making and outcomes.

49 49 iii. Develop a culture of continuous learning at the LSAB At each of its business meetings, the LSAB ensured that at least one topic was included which provided members of the Board with a learning opportunity. The following areas were covered: Mental Capacity Act Deprivation of Liberty Safeguards (in the context of Neary v London Borough of Hillingdon and Manchester Council v G, E and F) Learning the Lessons from Serious Case Reviews independent research findings The LSAB held its second annual review in June There were three main elements to the event a look back at the previous year (2010/2011); agreement on the objectives/priorities for 2011/2012 and an evaluation of the effectiveness of the Board. At the review there was also a decision to restructure the sub-groups working to the Board (see section 1.2 above). The 2012 annual event is scheduled for June 22 nd and will include a formal review of practice, impact and outcomes. The 2012 review day will also provide an opportunity to benchmark local progress against best practice and look ahead at any likely changes e.g. the Government s proposal to put LSAB s on a statutory footing. iv. Improve understanding of local referral patterns, enabling improved planning of responses to allegations Statistical data has been presented quarterly to the LSAB enabling debate about the effectiveness of local arrangements. The end of year statistics are shown in detail at Appendix 1 with headline messages and outcomes at section 2.4 (iv) above. v. Ensure contract compliance in relation to safeguarding adults at risk from harm As a new arrangement in 2011/2012, the Contracts Team now joins the Safeguarding Adults Team on a monthly basis to discuss any shared concerns about care service provision. This has enabled effective information sharing and agreement about which team will lead in each situation. The role of Age UK Harrow in seeking user satisfaction with care provision continued last year with two independent reports produced. There is routinely a question about dignity and the key messages are:

50 50 the percentage of service users reporting that their care workers always treat them with respect averaged 60.00% as a key part of the LSAB prevention strategy, this area will continue to be closely monitored again in 2012/2013 Theme 4 Policies and procedures/governance i. Continue to oversee the implementation of the pan London procedures The new pan-london Policy and Procedures were finalised and agreed in 2010/11 and the official launch took place in Harrow on World Elder Abuse Awareness Day 2011 (15 th June). The new procedures will be reviewed London wide in The multi-agency training programme covers the policy/procedures and Framework i was further modified to guide staff through best practice. Outcomes: File audit is demonstrating that the revised Framework i process is supporting staff in following the pan London procedures. All training and briefing sessions cover staff and/or managers responsibilities under the procedures. ii. Ensure production of the LSAB Annual Report/present to all organisations Boards/equivalent and Scrutiny Committee This Annual Report will be presented to the Scrutiny Committee on 9 th July Last year s request from Scrutiny to benchmark Harrow against national performance has been addressed in this report. LSAB members will ensure that it is taken to all relevant Boards or equivalent. Both an executive summary and an accessible version of this report will be produced by the end of September 2012 and will be made available on the Council and partner websites.

51 51 Harrow is a place where adults at risk from harm are safe and empowered to make their own decisions and where safeguarding is everyone s business (LSAB Vision) SECTION 5 OBJECTIVES FOR 2012/2013 (YEAR 3 OF THE BUSINESS PLAN)

52 52 5. Aims and objectives for 2012/2013 Year 3 of the Business Plan The following areas are the priorities in Year 3 of the LSAB Business Plan. Please see the Harrow LSAB Business Plan for comprehensive details about delivery and implementation. NB: user involvement, carer voice and accessibility will be addressed in all themed areas Theme 1 - Prevention and Community Engagement LSAB Sub Group Overall objective All the agencies in Harrow represented at the LSAB have agreed to take a zero tolerance approach to the abuse of adults at risk from harm. The vision for the Board adopted in 2011 states that Harrow is a place where adults at risk from harm are safe and empowered to make their own decisions and where safeguarding is everyone s business. As such the LSAB has agreed that the prevention of abuse (in both domestic and institutional settings), publicity campaigns and information provision which reaches all sections of the community should be a high priority. Action How it will be achieved and measured Timescale for achievement Implement Year 3 of the Safeguarding Adults at Risk Prevention Strategy As outlined in the Prevention Strategy End March 2013 Source: CQC

53 Actively use the media for publicity campaigns Source: AR Specific campaigns will be focused on sections of the community where the fewest referrals were received in 2011/12 i.e. physical disability and mental health 53 End March 2013 Run high profile campaigns e.g. WEAAD incorporating the zero tolerance and safeguarding is everyone s business messages Source: ADASS Campaigns to be linked with national programmes (for maximum coverage & effect e.g. Carers Week) minimum 4 campaigns annually WEAAD 2012 will focus on financial crime against older people with an event in the town centre in partnership with the Police, HAD and Age UK End March 2013 Adopt a different approach to community engagement Source: AR Improve community safety and address hate crime in relation to vulnerable adults at risk Source: I&DeA Specific campaigns will be focused on the BME community, self funders and care groups where the fewest referrals were received in 2011/2012. The LSAB has agreed to target more generic locations where everyone goes e.g. supermarkets, hairdressers, GP/dental surgeries, schools and vets Explore running a keeping safe event with the LSCB, Police and Community Safety End March 2013 End March 2013

54 Improve access to the Criminal Justice system for victims Source: ADASS The SGVAT will continue to work with the Police to support victims in following through relevant prosecutions 54 End March 2013 Ensure risk assessments are completed and suitable information is available for self funders and people with Personal Budgets Source: CQC/ADASS Participate in the Police led project with the Banks on doing more targeted work to protect older vulnerable people at risk from financial abuse, bank follow offs and distraction burglary etc Source: CQC/file audit/i&dea Develop local care home risk assessment tool Safeguarding Adults Team staff will continue to support the Personalisation Teams and Harrow Association For Disability in strengthening advice and information available to users of Direct Payments and/or Personal Budgets, including implementation of new risk assessment process File audit will measure compliance with risk assessments. Explore holding an information event for older and vulnerable people at risk to coincide with Older People s Day 2012 in October A Harrow version of the West Sussex tool (circulated by NHS London) will be piloted in 2012 End March 2013 End March 2013 End September 2012 Source: Winterbourne Final version to be launched in 2013 End March 2013

55 55 Theme 2 Training and Workforce Development LSAB Sub Group Overall objective In adopting the ADASS standards for Safeguarding Adults at risk, the LSAB has signed up to a multi-agency workforce development/training strategy. In addition, the main messages drawn from the Bournemouth University/Learn To Care research (May 2010) Towards a National Competence Framework for Safeguarding Adults suggests that there needs to be better coordination, quality and breadth of multi-agency staff training. Action How it will be achieved and measured Timescale for achievement Implement the refreshed training programme and monitor the uptake and feedback on the new e-learning option Source: ADASS/BU User satisfaction will be measured to determine the effectiveness of the new training programme and e-learning options End March 2013 Continue to run Mental Capacity Act and Deprivation Of Liberty Safeguards (DOLS) training refining course content based on file audit and case review findings Improvements to practice will be monitored through file audit End March 2013 Source: I&DeA/ADASS

56 Ensure effective use of the Deprivation of Liberty Safeguards (DOLS) in Harrow Source: AR Review DOLS implementation, to include the development of proposals for the Council s new duty to make assessments and DOLS authorisations in hospitals (subject to the successful passage of the Health and Social Care Bill) 56 End March 2013 Oversee best practice forums for frontline staff from across all relevant local organisations Source: CQC Work collaboratively with the Clinical Commissioning Group Board (CCGB) of GPs to ensure safeguarding adults is addressed in its change agenda for local NHS services Source: I&DeA Establish a LSAB/LSCB sub group to take forward relevant joint work e.g. community engagement, training and workforce development, safer recruitment practices A minimum of 3 Best Practice Forums are held each year topics linked to file audit and case review findings Carry out a briefing session for the GPs on the CCGB Attend relevant consultation/planning events as appropriate 5 more GP surgeries will have received SGA awareness sessions Sub Group will develop a work programme which will be considered at the September LSAB business meeting End March 2013 End March 2013 End September 2012

57 57 Theme 3 Quality and Performance Review LSAB Sub Group Overall objective The LSAB has agreed to oversee robust performance management frameworks for monitoring the quality and effectiveness of safeguarding work across all sectors. The existing QA framework is shown at Appendix 3 and has user/carer challenge at its centre. Action How it will be achieved and measured Timescale for achievement Oversee the implementation of the Mrs R Independent Case Review action plan Source: NS LSAB will receive a report at the September 2012 LSAB meeting End September 2012 Ensure that both independent and internal audit programmes take place Source: CQC/I&DeA A minimum of 40 externally audited and 30 internally audited cases will be completed each year in the Council findings, actions and resulting outcomes to be reported to the LSAB LSAB partner agencies to report for the 2012/2013 Annual Report on audit findings from their own governance arrangements End March 2013 End May 2013

58 58 Ensure contract compliance in relation to safeguarding vulnerable adults at risk Source: C&C Improve understanding of local referral patterns, enabling improved planning of responses to allegations Source: AR That the Contracts Team write to the relevant SGA Team in boroughs where Harrow is intending to place a client into residential care. The letter will seek information about any safeguarding concerns that the host authority may have about the home Statistical data will be available for presentation to the LSAB at each meeting and for inclusion in the LSAB Annual Report 2012/13 Benchmark Harrow AVA statistics with comparator boroughs/national data and make recommendations to the LSAB for any actions required LSAB to receive a report at the Annual Review Day in June 2012 with recommendations for actions resulting from data analysis Ongoing End June 2013

59 59 Theme 4 - Policies and Procedures/Governance LSAB Sub Group Overall objective In adopting the ADASS standards for Safeguarding Adults at risk, the LSAB has signed up to a multi agency partnership, oversight by each organisation s executive body to the work and the pan London Policy & Procedures that describe the framework for responding to alerts/referrals. Action How it will be achieved and measured Timescale for achievement Ensure production of the LSAB Annual Report Source: AR Ensure the annual report is presented to all organisations Boards/equivalent Source: ADASS Ensure that the LASB Annual Report is presented to Scrutiny Committee Source: I&DeA LSAB receive Annual Report within 3 months of the end of each financial year All members of LSAB present the Annual Report to their Boards/equivalent Presentation made to Scrutiny to include progress against the 2012/13 action plan and objectives for 2013/14, plus comparisons with AVA data from comparator boroughs End June 2013 End September 2013 End July 2013

60 Write an accessible User Engagement Strategy for safeguarding adults work Source: AR/ADASS The Strategy will include details about: easy to read publicity/information; how feedback from vulnerable adults at risk influences the work of the LSAB; following victims up at the end of the safeguarding process to identify whether their desired outcomes were met 60 End December 2012 Ensure excellence in local practice Provide options for the LSAB to consider on a process of peer review End March 2013 Source: I&DeA Source Documents: AR Local Safeguarding Adults Board Annual Report/local priority ADASS Association of Directors of Adult Social Services/LGC/NHS Confederation/SCIE Standards for Adult Safeguarding 2011 CQC - CSCI Study Effectiveness of Arrangements to Safeguard Adults From Abuse (November 2008) C&C - Best Practice in Contracts & Commissioning I&DeA - I&DeA Peer Review (June 2010) NS No Secrets guidance BU - Bournemouth University/Learn To Care research Towards A National Competence Framework For Safeguarding Adults (May 2010) Winterbourne - Implementation of the Winterbourne View recommendations File Audit

61 Harrow is a place where adults at risk from harm are safe and empowered to make their own decisions and where safeguarding is everyone s business (LSAB Vision) SECTION 6 - APPENDICES

62 Safeguarding Adults Alert & Referral Data - 1st April th March 2012 Summary Statistics No. of Alerts: % Taken forward as Refs: % Dealt with at Alert Stage: % No. of Repeat Refs: % No. of Completed Refs: % Alerts Female % Alerts Male % Not Stated / Recorded 0 0% % Referrals Female % Referrals Male % Not Stated / Recorded 0 0% % From different Ethnic Backgrounds (non white): % Female % Male % (ethnicity) Not Stated / Recorded 0 0% % W/UK BME From different Ethnic Backgrounds (white): From different Ethnic Backgrounds (non white): - 60% 40% From different Ethnic Backgrounds (non white): % Female 86 39% Male 74 33% (ethnicity) Not Stated / Recorded 0 0% % W/UK BME From different Ethnic Backgrounds (white): From different Ethnic Backgrounds (non white): - 55% 45% Where Abuse / Harm took Place: - Own Home % Care Home - Permanent 46 13% Care Home with Nursing - Permanent 29 8% Care Home - Temporary 7 2% Care Home with Nursing - Temporary 5 1% Alleged Perpetrators Home 7 2% Mental Health Inpatient Setting 2 1% Acute Hospital 1 0% Community Hospital 5 1% Other Health Setting 2 1% Supported Accommodation 19 5% Day Centre/Service 4 1% Public Place 10 3% Education/Training/Workplace Establishment 3 1% Other 25 7% Not Known / Not Recorded 16 4% % A l e r t s R e f e r r a l s Many cases involve multiple locations of abuse and this is highlighted in these figures Client Group: - Older People % Learning Disability 79 22% Physical disability 21 6% Mental Health 50 14% Substance Misuse 3 1% Other Adult at Risk 20 6% Not Stated / Recorded 0 0% %

63 Type of Abuse / Harm: - Physical % Sexual 24 5% Emotional/Psychological % Financial 89 19% Neglect 86 18% Discriminatory 3 1% Institutional 29 6% Not Stated / Recorded 0 0% Multiple Abuses 91 19% % Many cases involve multiple abuses and this is highlighted in these figures Person Alleged to have caused Abuse / Harm:- Health Care Worker 5 1% Neighbour or Friend 30 9% Other Family Member 88 25% Other Professional 3 1% Other Vulnerable Adult 22 6% Partner 43 12% Social Care Staff 76 22% Stranger 8 2% Volunteer or Befriender 1 0% Other 20 6% Not Known/Stated/Recorded 56 16% % Outcomes for Adult at Risk (completed cases) :- Increased Monitoring 57 15% Removed from property or service 20 5% Community Care Assessment & Services 48 12% Civil Action 2 1% Apllication to Court of Protection 2 1% Application to change appointee-ship 0 0% Referral to advocacy scheme 1 0% Referral to Counselling/Training 5 1% Moved to increase/different Care 12 3% Management of access to finances 6 2% Guardianship/Use of Mental Health Act 1 0% Review of Self Directed Support (IB) 5 1% Management of access to Perpetrator 19 5% Referral to MARAC 1 0% Other 52 13% No Further Action % % Outcomes for Person Alleged to have caused the Abuse / Harm (completed cases) :- Criminal Prosecution/Formal Caution 6 2% Police Action 25 7% Community Care Assessment 10 3% Removal from Property or Service 17 5% Management of access to Vulnerable Adult 10 3% Referred to PoVA List/ISA 2 1% Referral to Registration Body 5 1% Disciplinary Action 8 2% Action By Care Quality Commission 5 1% Continued Monitoring 29 8% Counselling/Training/Treatment 10 3% Referral to Court Mandated Treatment 0 0% Referral to MAPPA 1 0% Action under Mental Health Act 4 1% Action by Contract Compliance 5 1% Exoneration 6 2% No Further Action % Not Known 41 11% % Many cases allow for multiple outcomes and this is highlighted in these figures Many cases allow for multiple outcomes and this is highlighted in these figures

64 No. of Alerts & Referrals No. of Alerts & Referrals 350 Safeguarding Adults Alerts & Referrals 1st April th March 2012 Male / Female Ratio Alerts Female Alerts Male Not Stated / Recorded Referrals Female Referrals Male Not Stated / Recorded Total No. of Alerts Proceeding to Referrals Safeguarding Adults Alerts & Referrals 1st April th March 2012 Male / Female Ratio ( from different ethnic backgrounds ) 104 Female Male (ethnicity) Not Stated / Recorded 0 0 Total No. of Referrals (21 did not state / record ethnicity but did record gender) % of overall referrals - 36% Safeguarding Adults Alerts 1st April th March 2012 W/UK / BME Ratio 142 / 36% BME 258 / 65% White UK / Other % BME Community in Harrow (from 2001 Census ) %

65 No. of Referrals No. of Referrals No. of Referrals Safeguarding Adults Referrals 1st April th March 2012 Referrals by Type of Alleged Abuse Total No. of Referrals Safeguarding Adults Referrals 1st April th March 2012 Referrals by Client Group Older People Learning Disability 21 Physical disability Mental Health 3 Substance Misuse 20 Other Adult at Risk 0 Not Stated / Recorded Total No. of Referrals Safeguarding Adults Referrals 1st April th March 2012 Referrals by Location of Abuse Total No. of Referrals - 192

66 No. of Referrals No. of Referrals No. of Referrals Safeguarding Adults Referrals 1st April th March 2012 Referrals by Alleged Perpetrator Total No. of Referrals Safeguarding Adults Referrals 1st April th March 2012 Outcomes for Alleged Victim Total No. of Referrals Safeguarding Adults Referrals 1st April th March 2012 Outcomes for Alleged Perpetrator Total No. of Referrals - 192

67 Physical Table 1 Organisation code: Harrow Form Number: WorkArea: AVA1011 Period: 01/04/2011 Table 1: Number of alerts, referrals, repeat referrals and completed referrals by age, primary client group and gender of vulnerable adult Alerts Referrals Repeat Referrals Completed Referrals Female Male Total Female Male Total Female Male Total Female Male Total Age group: disability,frailty and sensory impairment (Total) Of which: Sensory Impairment Mental Health (Total) Of which: Dementia Learning Disability Substance misuse Other Vulnerable People Total aged Physical disability, frailty and sensory impairment (Total) Age group: Of which: Sensory Impairment Mental Health (Total) Of which: Dementia Learning Disability Substance misuse Other Vulnerable People Total aged Physical disability, frailty and sensory impairment (Total) Age group: Of which: Sensory Impairment Mental Health (Total) Of which: Dementia Learning Disability Substance misuse Other Vulnerable people Total aged Physical disability, fraility and sensory impairment (Total) Age group: 85+ Of which: Sensory Impairment Mental Health (Total) Of which: Dementia Learning disability Substance misuse Other Vulnerable People Total aged 85 and over Total (18+) Excluding Unknown Full Total (18+) Including Unknown Of which No. Placed by other authority from outside council area No. known to CASSR at time of alert / referral

68 Table 2 Organisation code: Harrow Form Number: WorkArea: AVA1011 Period: 01/04/2011 Table 2: Number of alerts, referrals, repeat referrals and completed referrals by ethnicity of vulnerable adult. Alerts Referrals Repeat Referrals Completed Referrals Total Total Total Total White British White Irish White Traveller of Irish Heritage Gypsy/Roma Any other White background White and Black Caribbean Mixed White and Black African White and Asian Any other Mixed background Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background Caribbean Black or Black British Other Ethnic Groups Not stated African Any other Black background Chinese Any other ethnic group Refused Information not yet obtained Total

69 Table 3 Organisation code: Harrow Form Number: WorkArea: AVA1011 Period: 01/10/2011 Table 3: Source of referral, by age and primary client group of vulnerable adult. Social Care Staff (CASSR & Independent) - Total Of which Physical disability, frailty and sensory impairment (Total) Mental Health Needs (Total) Learning Disability Substance misuse Other Vulnerable People TOTAL TOTAL TOTAL Domiciliary Staff Social Care Staff Residential Care Staff Day Care Staff Social Worker/Care Manager Self-Directed Care Staff Other Health Staff - Total Of which Health Staff Primary/Communit y Health Staff Secondary Health Staff Mental Health Staff Self Referral Family member Friend/neighbour Other service user Other Sources of Referral Care Quality Commission Housing Education/Training /Workplace Establishment Total Police Other Overall Total

70 Tables 4a & 4b Organisation code: Harrow Form Number: WorkArea: AVA1011 Period: 01/04/2011 t Table 4a: Nature of alleged abuse, for referrals, by age and gender of vulnerable adult Physical Sexual Emotional/psycholo gical Total 18+ Female Male Total Female Male Total Female Male Total Financial Neglect Discriminatory Institutional Total of which: Included multiple types of abuse** Table 4b: Nature of alleged abuse, for referrals, by age and primary client group of vulnerable adult. Physical Sexual Emotional/psycholo gical Physical disability, frailty and sensory impairment Mental Health (Total) Learning Disability Substance Misuse Other Vulnerable People 85+ Total Financial Neglect Discriminatory Institutional TOTAL TOTAL TOTAL TOTAL TOTAL Total of which: Included multiple types of abuse** * Multiple Entries are permitted in this table**unique count of referrals where multiple types of abuse took place

71 Tables 5a & 5b Organisation code: Harrow Form Number: WorkArea: AVA1011 Period: 01/04/2011 t Table 5a: Location alleged abuse took place, for referrals, by age of vulnerable adult. Total and over and over Own Home Care Home - Permanent Care Home with Nursing - Permanent Care Home - Temporary Care Home with Nursing - Temporary Alleged Perpetrators Home Mental Health inpatient setting Acute Hospital Community Hospital Other Health Setting Supported Accommodation Day Centre/Service Public Place Education/Training /Workplace Establishment Other Not Known Total * Multiple entries are permitted in this table:(a person should be recorded under each location where abuse is alleged to have taken place) Table 5b: Type of service, for referrals, by age and primary client group of vulnerable adult* and Over 18 and over Physical disability, frailty and sensory impairment Mental Health Learning Disability Substance misuse Other Vulnerable People Total Total Total Own Council Commissioned Service Commissioned by Another CASSR Self Funded service Service funded by Health No Service Total * Multiple entries are permitted in this table:(a person may be receiving more than one type of service at the time of the referral)

72 Partner Tables 6a & 6b Organisation code: Harrow Form Number: WorkArea: AVA1011 Period: 01/04/2011 Table 6a: Relationship of vulnerable adult to alleged perpetrator(s), for referrals, by age and gender of the vulnerable adult. Aged Aged 65+ Total Female Male Total Female Male Total Female Male Total Other family member Health Care Worker Volunteer/Befriend er Social Care Staff - Total Of Which: Social Care Staff Domiciliary Care staff Residential Care staff Day Care staff Social Worker/Care Manager Self-Directed Care Staff Other Other professional Other Vulnerable Adult Neighbour/Friend Stranger Not Known Other Total of above Of Which: Totals The alleged perpetrator lives with the vulnerable adult The alleged perpetrator is the main family carer *Multiple Entries are permitted in this table Table 6b: Relationship of vulnerable adult to alleged perpetrator(s), for referrals, by age and primary client group of the alleged victim. Aged Aged Aged Aged 85+ Total Physical disability, frailty and sensory Mental Health (Total) Learning Disability Substance misuse Other Vulnerable People Total Total Total Total Total impairment Partner Other family member Health Care Worker Volunteer/Befriend er Social Care Staff - Total Of Which: Social Care Staff Domiciliary Care staff Residential Care staff Day Care staff Social Worker/Care Manager Self-Directed Care Staff Other Other professional Other Vulnerable Adult Neighbour/Friend Stranger Not Known Other Total of above Of Which: Totals The alleged perpetrator lives with the vulnerable adult The alleged perpetrator is the main family carer *Multiple Entries are permitted in this table

73 Tables 7a & 7b Organisation code: Harrow Form Number: WorkArea: AVA1011 Period: 01/04/2011 Table 7a: Case conclusion of completed referrals, by age and primary client group of vulnerable adult. Substantiated Partly Substantiated Not Substantiated Not Determined /Inconclusive Physical disability, frailty and sensory impairment (Total) Age Group Mental Health (Total) Learning Disability Substance misuse Other Vulnerable People Total Total Other Age Groups Total Total 85 and over Total Total 18 and over a Validation table Row Totals Sum Columns A-D Total Total Total Total Table 7b: Case conclusion of completed referrals, by ethnicity of vulnerable adult. Substantiated Partly Substantiated Not Substantiated Not Determined /Inconclusive White British White Irish White Traveller of Irish Heritage Gypsy/Roma Any other White background White and Black Caribbean Mixed White and Black African White and Asian Any other Mixed background Indian Asian or Asian British Pakistani Bangladeshi Any other Asian background Caribbean Black or Black British Other Ethnic Groups African Any other Black background Chinese Any other ethnic group Refused Not stated Information not yet obtained Total Total

74 Tables 8a, 8b & 8c Organisation code: Harrow Form Number: WorkArea: AVA1011 Period: 01/04/2011 Table 8a: Outcome of completed referral for vulnerable adult, by age and primary client group of vulnerable adult.* Total Physical disability, frailty and sensory Mental Health (Total) Learning Disability Substance misuse Other Vulnerable People impairment TOTAL TOTAL TOTAL TOTAL TOTAL Increased Monitoring Vulnerable Adult removed from property or service Community Care Assessment and Services Civil Action Application to Court of Protection Application to change appointeeship Referral to advocacy scheme Referral to Counselling / Training Moved to increase / Different Care Management of access to finances Guardianship/Use of Mental Health act Review of Self- Directed Support (PB) Restriction/manage ment of access to alleged perpetrator Referral to MARAC Other No Further Action Total * Multiple entries are permitted in this table Table 8b: Number of completed referrals leading to Serious Case Review by age and primary client group of vulnerable adult Total Physical disability, frailty and sensory Mental Health (Total) Learning Disability Substance misuse Other Vulnerable People impairment TOTAL TOTAL TOTAL TOTAL TOTAL No. completed referrals leading to serious case review Table 8c: Acceptance of Protection Plan by age and primary client group of vulnerable adult Total Physical disability, frailty and sensory impairment Mental Health (Total) Learning Disability Substance misuse Other Vulnerable People TOTAL TOTAL TOTAL TOTAL TOTAL Yes No Could not consent Total

75 Table 9 Organisation code: Harrow Form Number: WorkArea: AVA1011 Period: 01/04/2011 t Table 9: Outcome of completed referral for Alleged perpetrator / Organisation / Service by age and primary client group of vulnerable adult.* Total Physical disability, frailty and sensory impairment Mental Health (Total) Learning Disability Substance misuse Other Vulnerable People TOTAL TOTAL TOTAL TOTAL TOTAL Criminal Prosecution / Formal Caution Police Action Community Care Assessment Removal from property or Service Management of access to the Vulnerable Adult Referred to PoVA List/ISA** Referral to Registration Body Disciplinary Action Action By Care Quality Commission Continued Monitoring Counselling/Trainin g/treatment Referral to Court Mandated Treatment Referral to MAPPA Action under Mental Health Act Action by Contract Compliance Exoneration No Further Action Not Known Total * Multiple entries are permitted in this table **Independent Safeguarding Authority

76 76 Appendix 2 LSAB PREVENTION STRATEGY end of year progress (as at 31/3/2012) Action point Lead Sub group End of year update Introduction/Principles All agencies have agreed to take a zero tolerance approach to the abuse of vulnerable adults Tier 1 Generic Activities All agencies to implement the 10 Dignity in Care Challenges and to report progress in the LSAB Annual Report LSAB representatives/senior managers LSAB representatives/senior managers Agreed at LSAB All relevant campaigns and publicity now reinforce this message for Harrow Completed Dignity work has continued in each organisation throughout the year

77 77 Rolling training programme to include section on recognising triggers of carer burnout Training and Learning Completed Ensure that there are articles in the local media a minimum of 3 times a year Run events for World Elder Abuse Awareness Day 2011 and start planning for WEAAD 2012 Publicity/Communication Completed Publicity/Communication Completed Develop an outreach programme into well used local places e.g. faith buildings and community groups Publicity and Communication A range of activities have taken place to date in 2011/2012 Further work required in 2012/2013 Ongoing Develop a document that provides accessible key messages from the local Multi-agency policy Publicity/Communication Completed All lead senior managers to ensure that they have disseminated the Multi-Agency Safeguarding Adults Policy widely within their organisation LSAB representatives/senior managers Completed Run targeted awareness events for service users, starting with priority groups i.e. learning disability, mental health, dementia, very elderly, the isolated Publicity/Communication Completed for 2011/2012 Further targeted sessions will be needed in 2012/2013

78 78 Awareness campaigns highlighting specific issues to the wider community will be run each year in partnership with Community Safety e.g. avoiding door step crime and keeping safe outside the home Publicity and Communication Ongoing SLAs to require care homes to run residents committees which can raise issues on behalf of those that cannot speak up for themselves SLAs for care homes/domiciliary care services to be explicit about dignity and the audit tool will check compliance e.g. look for residents committees which can raise issues on behalf of those that cannot speak up for themselves LSAB representatives/senior managers Contracts Team Ongoing Completed Tier 2 Staff Activities Each organisation will have a whistle blowing policy in place and ensure it is widely publicised Each organisation to ensure that any of their staff involved in visiting care service providers have a checklist to assist them in picking up relevant indicators of potential abuse LSAB representatives/senior managers LSAB representatives/senior managers All LSAB representatives have confirmed that this is in place for their organisation Completed Safeguarding Adults Team has produced a range of guidance sheets available to any staff or manager on request More work needed in 2012/2013

79 79 LSAB senior managers to ensure that their organisation has robust recruitment procedures in line with best practice Organisations to ensure that any volunteers they use have been appropriately vetted Volunteers to be offered free access to the local training programme LSAB Training Strategy will clearly identify which level of training should be provided to each staff group in the borough (i.e. be competency based) All organisations will ensure that their staff are provided with levels of supervision in line with their own Policy All organisations to develop a set of guidelines for staff as outlined at section 3.6 of the Prevention Strategy JDs and Person Specs for relevant posts to include reference to the dignity in care philosophy LSAB representatives/senior managers LSAB representatives/senior managers Training and Learning Training and Learning LSAB representatives/senior managers LSAB representatives/senior managers LSAB representatives/senior managers All LSAB representatives have confirmed that this is in place for their organisation Completed Ongoing Completed Completed All LSAB representatives have confirmed that this is in place for their organisation Completed Safeguarding Adults Team has produced a range of guidance sheets which cover these topics and are available to all organisations on request Completed Ongoing (Dignity Strategy)

80 80 Formal interview questions for care posts will include at least one question about preserving dignity of the patient/user Induction processes will cover the dignity agenda Supervision/performance appraisal meetings with relevant care staff will include a review of dignity in care initiatives Tier 3 Specialist Activities Safeguarding Adults Team staff will support the Self Directed Support Team and Harrow Association For Disability in strengthening advice and information available to users of Direct Payments and/or Personal Budgets Feedback from users organising their own care will inform future revisions of publicity materials LSAB Managers responsible for negotiating contracts to ensure that provider track record in safeguarding adults is a factor in tender assessment/award LSAB representatives/senior managers LSAB representatives/senior managers LSAB representatives/senior managers User/Carer Publicity and Communication LSAB representatives/senior managers New action for 2011/ ongoing (Dignity Strategy) New action for 2011/ ongoing (Dignity Strategy) New action for 2011/ ongoing (Dignity Strategy) Ongoing New approach to obtaining independent user feedback developed in 2011/2012 and will be implemented in 2012/2013 Completed

81 81 LSAB Managers responsible for negotiating with providers to ensure that it is a contractual requirement for them to work to the Harrow Safeguarding Adults Policy Customer satisfaction and consultation exercises will request feedback regarding the respect of dignity Continue to support local (unpaid) carers through information, advice and support services Complaints Teams will highlight with LSAB managers any dignity concerns arising through their work LSAB representatives/senior managers LSAB representatives/senior managers Carers Engagement Officer LSAB representatives/senior managers Completed and ongoing. Provider Forum meetings included a session on safeguarding and dignity. A specific event was also run for care providers on dignity in home care services following receipt of the Equality Commission report recommendations New action for 2011/2012 ongoing. Some actions have taken place e.g. new questions in the Age UK user domiciliary care survey (Dignity Strategy) Ongoing New action for 2011/2012 (Dignity Strategy)

82 82 A Appendix 3 Safeguarding Vulnerable Adults at Risk in Harrow Quality Assurance Framework Independent Challenge Provider Challenge External audit Inspections Improvement Board & equivalents Scrutiny Committee Peer review Continuous Learning All learning and training is: multi-agency, competency based & evaluated (annually) LSAB learns from inquiries Performance Indicators SCRs inform learning and development Best practice forums User & Carer Challenge complaints research surveys audit Data collection and analysis Contract and SLA monitoring Dignity toolkit/monitoring Professional Challenge Case file audit Peer Audit Care reviews Staff supervision and appraisal LSAB benchmarking best practice SGVA Team monitoring of practice 2

83 83 Appendix 4 Training Statistics 1. Formal training programme Cancellations/No Shows % Harrow Council 187 Harrow Council Internal % Health 131 Health 52 6% Statutory (other) 3 Statutory (other) 2 0% Private 148 Private 80 9% Voluntary 111 Voluntary 41 5% Total: 580 Total Cancelled (formal training) % 2. SGA Team Briefing Sessions Access Harrow Staff (06/03/2012) 50 Access Harrow TSO's x 3 sessions (18-20/07/2011) 30 Bradbury Court x3 sessions (03/06 & 08 & 18/07/11) 28 Community Mental Health Team Managers (27/09/2011) 7 Contract & Grants Monitoring Staff 10 Emergency Duty Team Manager 1 Harrow Equalities Centre - Community Groups (14/03/2012) 20 Harrow Helpline (12/05/2011) 12 Housing Team (05/10/2011) 15 Members Briefings (25/10/2011) 17 MIND Staff & Volunteers x3 sessions (17 & 30/01 & 07/02/2012) 30 Provider Forum - 35 Providers (19/03/2012) 60

84 84 Good Practice Forum on Child Protection for adults staff (21/09/2011) Adult Social Care 35 Mental Health Staff 7 NHS/Health Staff 3 Housing Staff 11 Private Sector Staff 5 Good Practice Forums on risk and mental capacity run by Michael Mandelstam x2 sessions (31/01 & 27/03/2012) Adult Social Care 99 Mental Health Staff 6 NHS/Health Staff 23 Voluntary Sector Staff 11 Housing Staff 1 Private Sector Staff 1 Service Users / Informal Carers 1 Good Practice Forum on mental capacity/dols for adult social care staff Service User Briefings Clamp Hill Day Centre (21/02/2012) 8 HAD Service User Briefings x3 sessions (25/07, 08 & 22/08/2011) 20 Kent House (26/01/2012) 18 Marlborough Hill Day Centre x2 sessions (03 & 16/02/2012) 18 Sheltered Housing Blocks (various) 50

85 85 Parkfield Nursing Home (27/09/2011) 10 The Bridge Day Centre (25/01/2012) Carer Briefings St. Peters Medical Centre Carers Group GP/Doctor/Medical Centres Belmont Health Centre 2 6. Commercial Briefings NatWest Bank x2 sessions (06/04 & 14/07/2011) 10 Total Attending 1258

86 86 Appendix 5 Harrow s Local Safeguarding Adults Board (LSAB) Terms of Reference Department of Health/Home Office Guidance NO SECRETS 2000 The Department of Health and the Home Office published NO SECRETS in March It was issued as guidance under Section 7 of the Local Authority Social Services Act NO SECRETS makes it a requirement for local authority Social Services Departments to take a lead in working in partnership with health care providers, the Police and the voluntary/private sector to: create a framework for action within which all responsible agencies work together to ensure a coherent policy for the protection of adults at risk of abuse Local authorities are required to: collaborate with public, voluntary, private sector agencies and with users and carers and involve them in developing an inter-agency response to safeguarding adults adopt a lead/co-ordinating role in the development of local Safeguarding Adults Policies and Procedures carry out a policy and service audit, develop a Safeguarding Adults Strategy and present an Annual Report to elected Members collect and collate monitoring information ensure that safeguarding adults is included in commissioning and contract monitoring develop a Training Plan and ensure that training is provided disseminate information Partner agencies have a responsibility to: work in collaboration with the local authority and other agencies investigate and take action when a vulnerable adult is believed to be suffering abuse produce internal guidelines appoint a lead officer

87 87 provide training for staff and volunteers draw up guidance on confidentiality disseminate information to staff and service users LSAB terms of reference Harrow s Local Safeguarding Adults Board (LSAB) is a multi-agency forum comprising of partners from the statutory sector (Council, PCT/NHS Acute and Mental Health Trusts, Police and CQC) together with partners from the private and voluntary sectors. Working with service users and carers at the heart of the process, the LSAB aims to: ensure effective partnership arrangements devise strategies to detect and prevent abuse from happening agree operational definitions and thresholds for intervention co-ordinate multi-agency safeguarding adults policies and procedures develop systems and structures to safeguard vulnerable adults in Harrow The roles and responsibilities of the LSAB Member agencies are responsible for their full and effective contributions to the work of the LSAB. This will include: to oversee the continued working of the Safeguarding Adults Policies and Procedures, including publication, distribution and administration of the procedures document to manage and audit multi-agency relationships relating to the implementation of the procedures document to review the policy and procedures on a two-yearly basis to reflect current experience and government guidance together with expectations and lessons learned from the monitoring process to make links with other areas of national and local policy development to develop good practice guidance relating to contracting, commissioning and care management to develop links across Child Protection, Domestic Violence, Direct Payments, and the Community Safety Plan etc to maintain a strategic overview of Safeguarding Adults training and oversee the implementation of a multi-agency training programme to secure funding from statutory agencies to support the work and infrastructure of safeguarding adults in Harrow to promote the awareness of safeguarding adults issues amongst staff/professionals in the statutory, private and voluntary sectors together with service users and carers and the wider community

88 88 to produce public information, organise events, and use available resources to publicise the work of the LSAB to promote a wider professional and public understanding of safeguarding adults through a variety of events or information campaigns to identify and secure adequate resources and funding to ensure there are sufficient skilled staff across agencies to undertake investigations as appropriate to develop a robust audit and monitoring system and cascade/implement the learning from those audits to improve performance and practice to use information from audit and monitoring to develop more robust protective measures and services to oversee the production of an Annual Report and Action Plan to identify and deliver on the LSAB s aims and objectives to present an Annual Safeguarding Adults report to Senior Officers, Members and to Executive Management Boards in line with good governance arrangements to ensure safeguarding adults and protection issues are effectively addressed/included in areas of strategic planning and within the Harrow Strategic Partnership to commission Serious Case Reviews where a vulnerable adult/s has been seriously injured or died as a result of adult abuse to liaise with other strategic groups e.g. the Local Safeguarding Children s Board (LSCB) and the Domestic Violence Steering Group on areas of mutual interest including training and awareness raising to oversee the work of the various LSAB work streams to deliver on identified aims and objectives and strategic priorities to support the Safeguarding Adults Co-ordinator in their role The LSAB will be quorate if one third of the membership is present that is also representative of the sectors and client groups Membership, accountability and decision making authority Representatives from partner organisations/agencies will be of sufficient seniority and authority within their agency to be able to take decisions and commit time/resources as appropriate to the work of the LSAB and associated work streams. The LSAB will have a standing membership from: Adult and Housing Services (including Contracts and Brokerage) Metropolitan Police Harrow Primary Care Trust (NHS Harrow) North West London Hospital Trust (NWLHT)

89 89 Central and North West London Mental Health NHS Foundation Trust (CNWL) Care Quality Commission (CQC) Independent Sector Providers The voluntary sector including Age UK, HAD, Mencap, MIND, etc User and Carer Groups Advocacy Services Harrow Commission for Race Equality (CRE) LSAB members are accountable to the agency they represent and are responsible for reporting back both at an operational and strategic level and for embedding safeguarding adults work within their agency and its governance arrangements. All representatives and agencies are jointly responsible for the actions of the LSAB. Other organisations/agencies or groups may be part of the LSAB or associated work streams for either a time limited period or permanently as appropriate and as decided by the LSAB. The LSAB will meet 4 times per year (with one additional meeting for an annual review), with the work streams meeting in between the board meetings and reporting back to the LSAB at each board meeting.

90 90 LSAB Membership (as at 31 st March 2012) LSAB Member Samuel Abdullahi Rachel Blaney Amanda Brady Mark Browne Paul Bushell Maggie Challoner Richard Coe Mike Coker Kim Cox Nick Davies Cllr Margaret Davine Angela Dias Seamus Doherty Yvonne Doyle Beverly Elgar Bernie Flaherty Mark Gillham Jaswant Gohil Treena Greany Sue Green Designation/Organisation Brent and Harrow Trading Standards Clinical Nurse Specialist for Safeguarding Vulnerable Adults Royal National Orthopaedic Hospital NHS Trust (RNOH) Business Relationship Manager- Care Quality Commission Continuing Care NHS Harrow and Brent London Ambulance Service Residents and Tenancy Manager Housing Services, Harrow Council LinkUp Carer Support - Harrow Service Manager, Harrow & Hillingdon, Adults (under 65), Central and North West London Foundation Trust Service Manager Contracts and Brokerage Harrow Council Portfolio Holder - Adult Social Care, Health and Wellbeing Chief Executive, Harrow Association of Disabled People Safeguarding Adults Co-ordinator - Adults & Housing, Harrow Council Ealing Hospitals NHS Trust Ealing Hospitals NHS Trust (Harrow Provider Services) Divisional Director Adult Social Care, Harrow Council Chief Executive - Mind in Harrow Harrow LINk Care UK Freemantle Trust

91 91 Mark Hall-Pearson John Hunter Anila Joshi Hitesh Karia Roma Keane DS Andrew Kilpatrick Andreas Kyriacou Sue Mackie Julian Maw Harriet Michael-Philips DCI Craig McKinlay Avani Modasia Paul Najsarek (Chair) Carole Newton Deven Pillay Visva Sathasivam Javina Sehgal Beverley Smith Sue Spurlock Georgina Wood Senior Professional - Harrow Mental Health Services Crossroads Care Hadley House/Stanmore Residential Care Home Director Gentle Care Mears Metropolitan Police Quality Assurance Manager, Vulnerable Children (LSCB representative) Deputy Director of Nursing - North West London Hospitals Trust Chair Harrow LINk Support for Living Metropolitan Police Harrow Chief Executive Age UK Harrow Corporate Director Adults & Housing, Harrow Council Borough Commander, London Fire Service Chief Executive - Harrow Mencap Assistant Director, Long Term Care and Safeguarding Adults, LBH Borough Director, NHS Harrow CNWL Older Adults Services Manager Safeguarding Adults Services - Adults & Housing, Harrow Council Direct Payments Support Scheme Manager & Acting Advocacy Manager, Harrow Association of Disabled People

92 92 Harrow is a place where adults at risk from harm are safe and empowered to make their own decisions and where safeguarding is everyone s business (LSAB Vision) SECTION 7 - FURTHER INFORMATION & CONTACT DETAILS

93 93 Further information/contact details For further information about this report or any aspect of safeguarding vulnerable adults at risk of harm in Harrow, the website is: If you are concerned about an adult that might be at risk of harm, or would like information or advice (including how to access the multi-agency training programme) the Safeguarding Adults Team can be contacted on the telephone number below or via at: The address for written correspondence is: Civic Centre (Second Floor East Wing) PO Box 7, Station Road, Harrow, Middx. HA1 2UH